Remote Network Compliance Auditor | RN, DHCS/CMS

SHPCA SCAN Health Plan; California (MO); Hybrid; USD 54,000 - 77,000; Full time

Benefits offered by this job

Annual bonus program

Wellness program

Generous PTO and holidays

401(k) with employer match

Tuition assistance

Job summary

SCAN Health Plan seeks an experienced nurse auditor to oversee DHCS auditing for PCP sites, including facility and medical record reviews. You will train providers, discuss corrective action plans, and ensure compliance with CMS, DHCS, NCQA, and SCAN requirements.

The role covers annual oversight, territory travel, and collaboration with Compliance to update SCAN policies and procedures. Strong attention to detail and analytical skills are essential.

Qualifications

• Registered Nurse license active in California.
• 2+ years clinical experience, including ER/acute care.
• IPA/Medical Group experience preferred.
• DHCS-CSR site reviewer preferred.

Responsibilities

• Review DHCS All Plan Letters and implement compliance plans.
• Audit SCAN contracted PCP offices for regulatory adherence.
• Provide training on auditing and post-audit documentation.
• Conduct closing meetings with audited providers and discuss CAPs.
• Respond to disputes over audit findings and escalate as needed.
• Analyze provider reports and regulatory interpretations for accuracy.

Skills

Analytical

Critical thinking

Problem solving

Communication

Attention to detail

Drive in territory

Education

RN license

Associate's Degree in Nursing

Bachelor's Degree preferred

DHCS-CSR certification preferred

Tools

MS Office

Data entry

Job description

SCAN Health Plan seeks an experienced nurse auditor to oversee DHCS auditing for PCP sites, including facility and medical record reviews. You will train providers, discuss corrective action plans, and ensure compliance with CMS, DHCS, NCQA, and SCAN requirements.

The role covers annual oversight, territory travel, and collaboration with Compliance to update SCAN policies and procedures. Strong attention to detail and analytical skills are essential.