Imperial Management Administrators Services
· LVN or RN license (for all or one of the following states: CA, TX, AZ, NM, NV, UT)
Conducts routine oversight, monitoring and auditing of all First, Tier, Downstream and Related entities (FDR)s to ensure compliance with state and federal standards. The Compliance Delegation Oversight Auditor will have Primary responsibility for reviewing and analyzing the FDRs performance and deciding on recommendation/action. In addition, assist the Compliance Officer/ Compliance Manager, and other staff within the Compliance Department as applicable with daily compliance functions. Compliance Delegation Oversight Auditor supports the Compliance team with the management and implementation of the Compliance program. Compliance Delegation Oversight Auditor will also serve as the department liaison regarding day to day compliance related activities for external inquiries.
ESSENTIAL JOB FUNCTIONS:
1. Inform FDRs of any changes to regulatory requirements.
2. Conduct mock audits and develop of corrective action plans to address any identified issues.
3. Conduct FDR pre-delegation audits to ensure vendors can perform delegated activities prior to delegation. Develop corrective action plan as needed.
4. Conduct annual delegation audits for applicable areas for existing delegated entities and ensure that vendors continue to perform the delegated activities in accordance with the agreement. Develop corrective action plan as needed.
5. Coordinate Delegation Oversight Committee meetings.
6. Act as a liaison for all FDRs for Compliance related activities.
7. Delegation Audit Areas are as follows, but not limited to: Claims, Credentialing, Organization Determinations Pre, and Post Service clinical and non-clinical, Network Adequacy.
· High school graduate or equivalent.
· Bachelor’s degree in healthcare field or equivalent experience that would provide the knowledge of duties listed above.
· Min 2 years experience within managed care plan and quality management
· Min 2 years audit experience in Claims, Credentialing, Utilization Management, and Privacy
Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff
To apply for this job please visit forms.office.com.