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Utilization Management Quality Reporting and Auditing Specialist I

Job Category: Clinical

Department: Utilization Management

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 12521

Salary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible for dynamically working with the quality team and UM Leadership to support and ensure effective implementation of reporting and auditing work plans and projects on behalf of L.A. Care’s Utilization Management Quality Program by working collaboratively and independently on components of reporting and auditing projects as assigned.

Duties

Ensures successful completion of assigned quality projects related to reporting, auditing, preparation and execution of external and internal audits while working with UM department to support quality projects including improvement and auditing and monitoring functions.

Completes projects related to the UM departments Quality and Compliance/Regulatory/Accreditation projects and cross functional departments and teams.

Supports the UM department with routine reporting and auditing/quality activities and work plans especially related to quality, reporting, regulations, accreditation and compliance.

Manages administrative activities related to reporting, compliance, and quality projects in the UM department.

Plans and organizes collaboratively and cross departmental meetings to problem solve, document issues and validate activities or reports.

In collaboration with leadership and trainers, provides education to staff based on results of audit findings, including but not limited to assisting with updating job aids and demonstration of compliant processes in group or individual meetings.

Applies knowledge of federal and state requirements/standards to ensure compliance for reporting and auditing.

Performs other duties as assigned.

Duties Continued

Education Required

Associate's Degree

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Bachelor's Degree in Business Administration or Related Field

Experience

Required:

At least 2 years of experience in a healthcare quality or quality/compliance role.

At least 6 monhts of experience in Utilization Management.

Experience navigating a EMR/ system.

Experience in using analytical skills related to reporting and data processing.

Skills

Required:

Ability to work under pressure with multiple deadlines.

Excellent verbal and written communication skills.

Ability to develop reports and documents on an as-needed basis.

Strong Microsoft Excel knowledge and skills

Knowledge of location of federal and state requirements and standards especially related to reporting and auditing.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

+ Paid Time Off (PTO)

+ Tuition Reimbursement

+ Retirement Plans

+ Medical, Dental and Vision

+ Wellness Program

+ Volunteer Time Off (VTO)