Clinical Network Compliance Auditor, Supervisor
Core
Supervises a team of auditors conducting financial, operational, compliance, and IT audit programs for Primary Care Provider (PCP) sites, focusing on DHCS, CMS, and NCQA regulatory requirements.
Role type
Senior IC clinical network compliance auditor (supervisor)
Builds
Quality improvement programs ensuring safe and effective clinical services for older adults
Domain
Healthcare / Managed Care / Medicare Advantage / Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
DHCS Certified site reviewer, DHCS Master Trainer, regulatory compliance analysis, audit program management, corrective action plan development, team supervision, contract interpretation, MS Office proficiency
Preferred skills
Bachelor's Degree, HMO/IPA/MSO experience, critical thinking, problem solving, stakeholder communication
Technologies
MS Office
Responsibilities
Supervise auditors conducting Facility Site Reviews (FSR) and Medical Record Reviews (MRR); create and distribute monthly audit assignments; prepare detailed reports of audit findings and corrective action requests; educate providers and staff on regulatory requirements; assist providers in achieving compliance and developing corrective action plans; represent the Delegation Oversight Unit in interdepartmental meetings; monitor regulatory environment and update department procedures.
Seniority
Senior, hands-on IC with team leadership