Healthcare Internal Auditor: Compliance & Regulatory

Community Health Group; Chula Vista (CA); Hybrid; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

Community Health Group is seeking an Internal Audits Division Auditor in California to monitor adherence across UM, CM, MS, Pharmacy, ECM/CS, and G&A. You will evaluate compliance with policies, procedures, and regulatory standards, providing analyses, findings, and CAPs to the Internal Audits Division Manager.

Qualifications include a healthcare-related bachelor’s degree and multiple years in managed care with auditing experience; proficiency in MS Office and QNXT is preferred.

Qualifikationen

• Bachelor’s degree in a healthcare-related field is required.
• Two or more years in a managed care setting, with at least one year of auditing experience.
• Solid healthcare and managed care background with knowledge of Medi-Cal and Medicare guidelines.
• Proficiency in Microsoft Office: Word, Excel, PowerPoint, and Outlook.
• Knowledge of QNXT and related software applications; ability to navigate internal data and systems.
• Excellent verbal and written communication skills, strong analytical abilities, and interpersonal skills.
• Excellent organizational skills with the ability to handle multiple tasks and/or projects simultaneously, prioritize work effectively, and demonstrate superior attention to detail.
• Ability to handle confidential, sensitive information with professionalism.
• Auditing of pharmacy department activities may require a Certified Pharmacy Technician with an Active California Pharmacy Technician license.

Aufgaben

• Regulatory Knowledge: In-depth understanding of DHCS, CMS, DMHC requirements and other related agencies.
• Document and maintain records of audits, findings, CAPs, and monitoring logs.
• Input audit data into scoring tools, report findings, and recommend corrective action.
• Support external or internal audits and accreditation surveys.
• Stay up to date with changes to state/federal regulations and accreditation standards.
• Collaborate with department management to prepare audit materials and improve processes.

Kenntnisse

Verbal and written communication

Analytical abilities

Interpersonal skills

Organizational skills

Problem-solving

Attention to detail

Ausbildung

Bachelor's degree in healthcare-related field

Certified Pharmacy Technician license (CA)

Tools

Microsoft Office (Word, Excel, PowerPoint, Outlook)

QNXT

Jobbeschreibung

Community Health Group is seeking an Internal Audits Division Auditor in California to monitor adherence across UM, CM, MS, Pharmacy, ECM/CS, and G&A. You will evaluate compliance with policies, procedures, and regulatory standards, providing analyses, findings, and CAPs to the Internal Audits Division Manager.

Qualifications include a healthcare-related bachelor’s degree and multiple years in managed care with auditing experience; proficiency in MS Office and QNXT is preferred.