Remote Health Plan Compliance Auditor

SCAN Health Plan; Long Beach, Northern (CA, KY); Hybrid; USD 54,000 - 77,000; Full time

Benefits offered by this job

Annual bonus program

Robust wellness program

Generous PTO + holidays

401(k) with employer match

Job summary

SCAN Health Plan seeks a registered nurse to lead auditing of PCP sites and ensure regulatory compliance across CMS/DHCS protocols. You will review facilities and medical records, deliver trainings, and guide corrective action plans. The role requires driving in assigned territory with a flexible remote/field work setup.

You will collaborate with Compliance and DOU teams to implement policy revisions and ensure high-quality care for SCAN members, while maintaining privacy and data accuracy.

Qualifications

• Registered Nurse license in California (current and active).
• 2+ years clinical experience, including ER/acute care preferred.
• IPA/Medical Group experience and DHCS-CSR certification preferred.
• Ability to work independently and in a team; strong analytical skills.

Responsibilities

• Conduct and oversee DHCS audits of PCP sites, including FSR and MRR.
• Prepare and deliver training on auditing processes and CAP development.
• Analyze DHCS All Plan Letters and regulatory language for compliance.
• Coordinate with DHCS-CMT, implement regulatory changes, and track CAPs.
• Communicate findings, support corrective actions, and maintain documentation.

Skills

Clinical nursing experience

Audit knowledge

Regulatory compliance

Communication skills

MS Office & data entry

Education

Associate's/Bachelor's degree in Nursing

Registered Nurse license (CA)

Job description

SCAN Health Plan seeks a registered nurse to lead auditing of PCP sites and ensure regulatory compliance across CMS/DHCS protocols. You will review facilities and medical records, deliver trainings, and guide corrective action plans. The role requires driving in assigned territory with a flexible remote/field work setup.

You will collaborate with Compliance and DOU teams to implement policy revisions and ensure high-quality care for SCAN members, while maintaining privacy and data accuracy.