Supervisor, Audit - Various, United States - Fidelis Care
Description
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Plan and conduct large scale audits, assessments, and reviews of identified areas to determine the effectiveness of internal controls, including those applicable to services and systems the organization provides to client/user entities. Assist with the development of audit tools and recommend improvements to audit programs.Manage products and processes related to medical management audits and act as a representative for the medical management auditing department.Audit and oversee analysis performed by clinical auditor trainers. Lead and direct clinical auditor trainers to ensure department processes are followed
Review, evaluate, and revise department policies and procedures and audit tool guidelines
Facilitate, coordinate, and execute Medical Management related meetings including weekly team meetings, audit committee meetings, and audit training sessions
Conduct large scale audit projects and serve as the lead regarding questions and issues
Prepare audit plans and conduct audit procedures, including interview of applicable personnel, test of valid audit sample transactions, and observation of current practices and policies
Prepare and draft reports of findings, exceptions, and recommendations for corrective action responsive to the observed deficiencies
Perform follow-up procedures to validate implementation and effectiveness of action plan, and make additional recommendations as warranted
Assist with assessing enterprise risk and developing audit tools and processes to mitigate risks
Assist with the development of audit methodology and ensure implementation into audit program
Education/Experience:
Bachelor's degree in Nursing or related clinical field or equivalent experience. 4+ years of nursing or quality assurance experience . Proficiency in UM/CM Medical Management processes, Microsoft applications, ability to work independently, familiarity with clinical documentation systems, and excellent leadership, communication, and oral/written skills. Previous experience as a team lead in functional area, supervising cross-functional teams on large scale projects or experience in hiring, training, mentoring, assigning work, and managing performance of staff.
License/Certification:
RN, LVN or LPN license. CCM preferred.
The salary range for NY is: $64,500 - $116,000
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.