CTG COMPLIANCE AUDITOR (RN) in Clayton, Missouri

Title: COMPLIANCE AUDITOR (RN)

Location: US-MO-Clayton

Job Number: 17203514

Compliance Auditor (RN)

Our client in the healthcare industry has an immediate opportunity for a full time Compliance Auditor (RN) in Clayton, MO. This is a full time, direct placement opportunity!

Our client is now one of the largest providers of Medicaid, Medicare Advantage, and other government-sponsored and commercial programs in the country. They provide access to affordable healthcare to more than 11 million members across the country.

This is a great opportunity to work with one of the fast growing Fortune 500 companies that has a multi-line healthcare enterprise that provides services to government healthcare programs. If you are selected for this opportunity you will be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. Our client’s employees are fast, agile, customer-focused multi-taskers with a commitment to implementing the latest technologies. If these same things get you excited, we hope to hear from you.

Responsibilities:

Lead, monitor and evaluate the performance of national delegated vendors according to CMS, NCQA, Federal and State requirements.

  • Lead compliance audits of vendors. Identify audit scope and required audit tools. Ensure audit results are appropriated compiled and accounted for within designated audit tools.

  • Manage, audit, and monitor both internal and external vendors against CMS, contractual, Federal, State, and NCQA standards.

  • Review vendors documented processes against contractual, Federal, State, CMS, and NCQA standards.

  • Identify process gaps and deficiencies and communicate audit observations, recommendations, and process improvement opportunities.

  • Develop and implement quality improvement and corrective action plans based on risk analysis, audit findings, and vendor performance.

  • Develop audit tools based on contracted services with vendors and requirements defined by CMS, State, Federal, Medicaid and/or NCQA guidelines.

  • Maintain documentation on vendor performance and provide reports to subsidiaries as required for audits and risk assessments. Lead vendor performance oversight meetings with impacted business owners and vendors.

  • Utilize clinical knowledge to determine audit findings and in answering counterclaims.

  • Train internal audit participants/business owners on audit tools and Medical Management criteria including CM, DM, and UM.

  • 30-35% travel required

Qualifications:

  • Bachelor’s degree in a clinical field or equivalent experience.

  • 4 years of combined clinical and compliance or auditing experience in a healthcare environment.

  • Familiarity with Health Insurance Marketplace, Medicaid and Medicare managed care practices and policies preferred.

Licensure/Certifications: Current state RN license required. Valid driver’s license.

To Apply:

To be considered please immediately apply to this requisition using the link provided. For additional information please contact Sara Wade at sara.wade@ctg.com or 716-882-8000 x4908. Kindly forward to any other interested parties- thank you!

Qualifications:

CTG is the most reliable IT services provider, built on 50 years of meeting our commitments to make technology work for clients and deliver real business value. CTG provides industry-specific IT strategy, services, and solutions that address the business needs and staffing challenges of clients in high-growth industries, including major technology companies, large corporations, and government entities located in North America and Western Europe.

CTG's greatest asset is its people, and as such we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work Company by Modern Healthcare (since 2013) in North America, and a Best Places to Work Company in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).

CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.

CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.

Job: Clinical Support