Delegation Utilization Auditor

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position location:  This position will allow for remote work flexibility, but selected candidate must have the ability to travel to either the Charlotte, NC or Durham, NC offices for occasional meetings and events.

Position Purpose: Ensure delegated provider groups are compliant with federal and state regulations. Identify instances of noncompliance among contracted provider groups and develop corrective action plans to meet regulatory and accreditations standards.

• Develop and implement compliance auditing and monitoring strategies for provider groups.
• Conduct root cause analysis, identify barriers to compliance and collaborate to develop successful rapid result corrective actions.
• Perform compliance audits, risk assessments, due diligence/pre contract audits and related ongoing compliance monitoring activities.
• Assess data collection and management process and recommend improvements for provider groups to meet regulatory compliance standards.
• Ensure the validation and integrity of data reports submitted by provider groups.
• Prepare documents and other information as requested by compliance standards organizations, including NCQA, for audits or in connection with accreditation initiatives.
• Serve as a companywide resource and liaison on delegation contract issues and provisions, communications, workflow, and corrective action /performance improvements initiatives.
• Makes recommendations to contracting on suitability of provider groups to support growth that supports compliance and performance.
• Communicate decisions on audit compliance to provider groups, communicate sanctions to provider groups that fail to demonstrate compliance and performance improvement.

Education/Experience:

• Bachelor’s degree in Public Health, Nursing, Public Administration, Social Work or related field. Master’s degree preferred.
• 3+ years of program evaluation and/or audit experience.
• Knowledge of managed care or healthcare systems, project management, case management, nursing, compliance, contracting

License/Certification: Valid driver's license required.

Pay Range: $54,000.00 - $97,100.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act