Clinical Auditor Sr - BCBA

Company Overview : Our client a leading healthcare provider based in Orange CA is seeking a senior clinical auditor who will ensure regulatory (MediCal) 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 BCBAD 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 : Onsite

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 noncompliance 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 nonclinical 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 nonsenior level staff within the department.

Assists with audits for special behavioral health initiatives or projects.

Completes other projects and duties as assigned.

Minimum Qualifications

Board Certified Behavior Analyst (BCBA) or Board Certified Behavior Analyst Doctoral (BCBAD) required.

5 years of clinical auditing experience or supervisory / management experience in a role over a Behavioral Health Treatment (BHT) / Applied Behavioral Analysis (ABA) team or related function.

Current California unrestricted license such as LCSW LPCC LMFT RN or LVN with BH experience preferred.

Possesses the Ability To :

• Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize be analytical problemsolve and possess project management skills.
• Work in a fastpaced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multiprogram teams and external committees / coalitions.
• Utilize computer and appropriate software (e.g. Microsoft Office : Excel Outlook PowerPoint Word) and jobspecific applications / systems.

Sunshine Enterprise USA is an Equal Opportunity Employer Minorities Females Veterans and Disabled Persons

Proficiency in advanced anesthesia techniques for cardiac surgeries. Strong knowledge of critical care principles and management of cardiac conditions. Excellent communication and interpersonal skills, with the ability to work collaboratively in a fast-paced, high-pressure environment. Detail-oriented with strong organizational skills. Ability to make quick and informed decisions during medical emergencies.

Education

Minimum of 3 years of experience in cardiac anesthesia and ICU care, preferably in a hospital or healthcare setting with a high volume of cardiac surgeries. Demonstrated expertise in managing critically ill cardiac patients in the ICU.