Enhanced Care Management Clinical Auditor LVN

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications.  A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization.  Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the full time position of Enhanced Care Management Clinical Auditor LVN in the range of $30.20 - $40.05 hourly.
 

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

PRIMARY PURPOSE: 

Under the direction of the Clinical Manager of Enhanced Care Management, the ECM Clinical Auditor LVN is responsible for reviewing and performing audits on participating ECM sites for DHCS core elements compliance. With the overall responsibility for auditing, reporting findings to management for review and providing recommendations for process improvement and assist with action plans for making those corrections. The LVN auditor will work in a coordinated effort with the Enhanced Care Management Manager to ensure smooth, efficient and productive auditing operations within the Enhanced Care Management Department for participating sites, as delineated by the Director of ECM.

CLASS CHARACTERISTICS:

This position will provide technical and clinical support to a Knox-Keene licensed health maintenance organization (HMO) Enhanced Care Management  Department.  The purpose of this position is to provide support to the Enhanced Care Management team for compliance, data collection, auditing and corrective action plan creation/maintenance for the participating ECM sites.

SUPERVISES: NO

MAJOR DUTIES & RESPONSIBILITIES:

• Maintains knowledge of all processes in the Enhanced Care Management Department.

• Completes audits for the Enhanced Care Management Department sites ensuring compliance.

• Shares information as necessary with appropriate ECM Clinical Staff.

• Maintain an effective, efficient, and confidential filing system both manual and electronic to allow easy retrieval and re-filing of department information.
• Maintains the confidentiality of records and reports for both the membership of KHS and the contract providers.
• Summarize and prepare necessary auditing reports for management;

• Performs other job-related duties as required;

• Adheres to all company policies and procedures related to employment and job Responsibilities.

CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS

• Lead by example to support a positive work environment that values patient advocacy, respectful listening, diverse expression of opinion and constructive conflict resolution;

• Adheres to KHS’s Code of Ethics and Business Conduct and all company policies; e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor;
• Represent KHS in a positive manner to all members, caregivers, staff and External stakeholders; 
• Demonstrate commitment to continuous improvement;
• Strong knowledge of acute chronic care nursing principles, methods and common treatments;
• Strong knowledge of common human diseases and usual and customary methods of treatments;
• Strong knowledge of all policy guidelines and APLs related to and surrounding the implementation and operationalization of the Enhanced Care management program as delineated by the DHCS or internal sources.
• Demonstrated knowledge of medical terminology;
• Ability to effectively evaluate medical records to determine appropriateness and necessity of care;
• Demonstrated knowledge of health care delivery systems;
• Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS;
• Ability to use tact and diplomacy to diffuse emotional situations;
• Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards;
• Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database;
• Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to,  patient healthcare, KHS business or employee information and make no disclosure of such information except as required in the conduct of business;
• Demonstrated ability to commit to and facilitate an atmosphere of collaboration and team work;
• Self-directed, with proven ability to work independently with minimum supervision;

Demonstrated ability to multi-task in an interrupt-driven environment and complete assignments on a timely basis;

• Strong attention to detail; work accurately and at a reasonable rate of speed;
• Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety.

Employee Standards

Education:

Licensed Vocational Nurse (LVN) with an active, current, unrestricted license

Experience:

Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required; Experience working with patients and caregivers regarding self-care and disease management required; Experience working in case management or care coordination is a plus; Knowledge and experience in a Quality Improvement setting or other experience with auditing is a plus.

Other:

Valid California Driver License and proof of state required auto liability. Up to 5% driving; Bilingual preferred.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.