Delegation Oversight Auditor (Full Telework)

Posted Date

12/20/2022

Department(s): Audit & Oversight

Reports to: Manager, Audit & Oversight

FLSA status: Non-Exempt

Salary Grade: I - $61,000 - $93,500

• Full Telework Opportunity***This position is a remote opportunity for Southern California Applicants. In order to be considered, you must live in Southern California or be willing to relocate.

Job Summary

The Auditor will conduct routine oversight, monitoring and auditing of internal business functions within CalOptima Health. The incumbent will ensure compliance with state, federal and accreditation standards.

Duties & Responsibilities

• Assists in the development of audit tools and issues corrective action plans to address identified issues.
• Participates in workgroups that address internal activities which need improvement and meet contractual requirements with the Center for Medicare and Medicaid (CMS), California Department of Health Services (DHS), California Managed Risk Medical Insurance Board (MRMIB), Department of Managed Health Care (DMHC) and other applicable entity.
• Ensures vendors remain in accordance with the regulatory requirements or contractual obligations.
• Informs various departments of changes to regulatory requirements.
• Serves as knowledge expert for assigned functional areas; may act as a liaison with other areas and business units.
• Participates in the Audit and Oversight Committee (AOC) meetings.
• Conducts annual audits for applicable areas.
• Completes other projects and duties as assigned.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Conducts validation audit for applicable areas of identified deficiencies to ensure all remediation efforts are effective and sustained.

Experience & Education

• 2 years of experience within a managed care plan and quality management required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
• 2 years of audit experience in the health care field required.
• 2 years of experience in claims, provider dispute resolution, customer service, credentialing, provider relations, provider data management services, grievance and appeals, the Program of All-inclusive Care for the Elderly (PACE) or another applicable area required.
• Bachelor’s degree in a health care field or related field required.

Physical Demands And Work Environment

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of the job, employee is required to move about the organization, as well as to offsite locations. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must be able to reach with hands and arms and must occasionally lift office supply boxes and laptop to and from various locations. Employee must be able to communicate, particularly for regular phone use and face-to-face interaction.
• Work Environment: Typical office environment with minimal to moderate noise levels depending on the time of day, and controlled office temperatures.

About Our Benefits & Wellness Options

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

Tracking Code

4129-117