Job Summary
The Clinical Compliance Auditor II is responsible for executing thorough audits within utilization management and clinical operations, ensuring compliance with established regulatory and contractual obligations. This position is pivotal in guiding the team through mentorship, enhancing processes, and creating frameworks for compliance monitoring.
Responsibilities
- Execute detailed audits of clinical operations and utilization management to ascertain compliance with regulatory standards.
- Provide mentorship and leadership to junior staff members.
- Identify opportunities for process enhancements to improve compliance efficiency.
- Develop and implement compliance monitoring frameworks to ensure ongoing adherence to standards.
Qualifications
- Active and unrestricted Registered Nurse (RN) license.
- A minimum of 3 to 5 years experience in utilization management or clinical auditing.
- Proficiency in Microsoft Office applications.
- Strong knowledge of Medicare and managed care compliance protocols.
