Registered Nurse (RN) Network Compliance Auditor, FSR (Los Angeles, CA)

SCAN Health Plan; Long Beach (CA); On-site; USD 54,000 - 77,000; Full time

Benefits offered by this job

Annual bonus program

Wellness program

PTO and holidays

401(k) with employer match

Tuition reimbursement

Job summary

SCAN Health Plan in Long Beach, CA seeks an experienced RN Network Compliance Auditor to lead auditing of PCP sites for regulatory compliance and quality improvement. The role emphasizes analysis, training, and implementing corrective actions.

The ideal candidate has an RN license in CA, 2+ years of clinical experience (ER/Acute care), and preferred auditing or IPA/Medical Group background. Full-time onsite position with benefits.

Qualifications

• 2+ years of clinical experience including ER/Acute Care.
• Auditing experience preferred.
• IPA/Medical Group experience preferred.
• DHCS-CSR certification preferred or obtainable within 1 year.
• Current RN license in California.

Responsibilities

• Conduct detailed reviews, analysis, and interpretation of regulatory letters.
• Identify areas for regulatory compliance and develop implementation plans.
• Facilitate auditing of SCAN contracted PCP offices.
• Provide training on auditing and post-audit documentation.
• Discuss audit outcomes with providers and ensure corrective actions.

Skills

Clinical auditing

Regulatory compliance

QA processes

Care quality improvement

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

About This Role

The Registered Nurse (RN) Network Compliance Auditor will oversee the Managed Care Plan's auditing team, conducting reviews of Primary Care Provider sites to ensure compliance with regulatory standards. This role is ideal for an experienced RN with strong analytical skills and a commitment to improving care for older adults.

Highlights

• Pay: $39 - $56/hour
• Location: Long Beach, CA
• Schedule: Full-time

What You'll Do

• Conduct detailed reviews, analysis, and interpretation of DHCS All Plan Letters (APL).
• Identify impactful areas for regulatory compliance and develop implementation communication plans.
• Facilitate auditing of SCAN contracted and collaborative PCP offices.
• Provide training on auditing and post-audit documentation.
• Conduct closing meetings with audited providers to discuss compliance audits.
• Assist providers in achieving and maintaining compliance with SCAN and regulatory requirements.
• Analyze submitted reports from providers and request corrections as needed.
• Communicate regulation interpretations and provide supplemental information.
• Conduct annual oversight projects and coordinate with internal SCAN staff.
• Educate providers on compliant delegated claims processing.

Requirements

Education:

• Associate's Degree in Nursing required, Bachelor's Degree preferred.

Experience:

• 2+ years clinical experience including ER/Acute Care nursing required.
• IPA, Medical Group experience preferred.
• Prior auditing experience preferred.

Licenses & Certifications:

• Current RN License in California required.
• DHCS-CSR (certified site reviewer) strongly preferred or ability to become certified within 1 year.

Benefits

• Annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO) and 11 paid holidays per year
• Excellent 401(k) Retirement Saving Plan with employer match
• Tuition reimbursement

About SCAN Health Plan

SCAN Health Plan is a nonprofit health organization dedicated to improving care for older adults. Founded in 1977, SCAN serves over 500,000 people across multiple states and focuses on delivering quality healthcare through innovative and compassionate services.