What are the responsibilities and job description for the Clinical Auditor (Sr.) - BCBA position at SUNSHINE ENTERPRISE USA LLC?
Job Description
Company Overview : Our client, a leading healthcare provider based in Orange, CA, is seeking a senior clinical auditor, who will ensure regulatory (Medi-Cal) and accreditation National Committee for Quality Assurance (NCQA) by conducting routine oversight, monitoring and auditing of Behavioral Health Treatment (BHT) / Applied Behavioral Analysis (ABA) to ensure compliance with state, federal and accreditation standards.
Position Summary : The ideal candidate is an BCBA or BCBA-D, with 5 years of clinical auditing experience or performed supervisory role over a behavioral health treatment / applied behavioral analysis team.
Work duration : Up to 6 months
Work hours : 8 : 30 am ~ 5 : 30 pm, Monday – Friday
Job type : On-site
Position Responsibilities
- Conducts ongoing analysis / assessment and auditing of operational performance for continuous process improvements, improved efficiency and improved customer satisfaction.
- Manages multiple concurrent and retrospective audits for quality and accuracy by comparing clinical processes against existing standards for the purpose of improving members’ quality of care, monitors efforts and related projects.
- Makes recommendations around objectives and scope of regulatory adherence, best practices related to clinical decision making and improving member care.
- Ensures effective and efficient audit execution.
- Identifies patterns of non-compliance and opportunities for improvement and develops corrective action plans to address any identified issues.
- Creates and updates audit tools to meet all regulatory requirements and the needs of Behavioral Health UM processes, along with presenting the audit tools and expectations to all department team members.
- Audit topics include but are not limited to : NCQA accreditation requirements Department of Health Care Services (DHCS) regulatory requirements Key performance indicators (KPIs)
- NCQA accreditation requirements
- Department of Health Care Services (DHCS) regulatory requirements
- Key performance indicators (KPIs)
- Participates in workgroups that address both clinical and non-clinical activities for which CalOptima Health must demonstrate improvement to meet its contractual requirements with the Center for Medicare and Medicaid (CMS), DHCS, NCQA and any other applicable entity.
- Establishes and facilitates routine communication and feedback mechanisms of findings to team members and management. Additionally, utilizes findings and trends to improve policies, procedures and general staff knowledge via training.
- Serves as subject matter expert (SME) for BHT / ABA clinical and quality areas.
- Serves in a lead capacity over non-senior level staff within the department.
- Assists with audits for special behavioral health initiatives or projects.
- Completes other projects and duties as assigned.
Minimum Qualifications
Possesses the Ability To :
Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”
Requirements
Salary : $45 - $55
