RN Auditor

We’re searching for an RN Auditor, someone who’s ready to be part of the best ranked children’s hospital in Texas, and among the best in the nation. In this position, you will complete associate quality audits of clinical staff, focused reviews, and problem identification. Provides coaching and feedback to associates as necessary. Provides routine/scheduled and ad hoc audit reports, including trend identification and root cause analysis. Coordinates development of action plans for identified issues. Participates and assists in the development of necessary protocols, policies and procedures, and operational strategies for Clinical Services. Provides a report tracking compliance with timeliness as mandated by applicable legislative and accrediting organizations, including trend identification and root cause analysis. Coordinates development of action plans for identified issues. Responsible for ongoing development of audit tools to meet business needs. Participates in Quality Reviews and Inter-Rater Reliability process as requested. Works with the management team to develop and provide individual and department-level performance improvement plans and activities as well as plan/process follow-up.

Think you’ve got what it takes?

Responsibilities:

• Performs monthly auditing of registered nurses and other clinical functions in 1 or more of the following areas: Utilization Management (UM) Case Management (CM) Member Assessment Team (MAT) Health Management (HM) and/or Disease Management (DM).
• Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed
• Assesses clinical staff regarding appropriate decision-making
• Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
• Ensures auditing approaches follow a standards in approach and tool use.
• Assists in preparation for regulatory audits by performing file review and preparation.
• Participates in regulatory audits as subject matter expert and fulfilling different audit team roles as required by management
• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications.
• Adheres to departmental standards, policies, protocols.
• Maintains detailed records of auditing results
• Assists training team with developing training materials or job aids as needed to address findings in audit results
• Meets minimum production standards
• May conduct staff training as needed.
• Communicates with manager about issues identified and works collaboratively to resolve/correct them.

Requirements:

• Required associate's degree in nursing with a preferred bachelor's degree in nursing
• Required RN - Lic-Registered Nurses by the Texas Board of Nursing or Nurse Licensure Compact
• Required 2 years' experience with Utilization Management, Case Management, Management Assessment Team, Health Management, Disease Management, and/or managed care experience
• Preferred 3 years' experience in utilization management, disease management or case management in managed care, medical or behavioral health settings
• Preferred 2 years clinical auditing/review experience 

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