**Remote/Field in Riverside County**

** Eligible for 10K sign on bonus, if DHCS-CSR (certified site reviewer)**

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, Nevada and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

The Job

This role, Network Compliance Auditor (FSR) Nurse, performs all aspects of a Facility Site Review (FSR), using regulatory requirements, to test, monitor, document and report the overall level of compliance of the First Tier, Downstream and related entities (FDR) to ensure compliance with all applicable requirements; SCAN, Federal, State and National Committee for Quality Assurance (NCQA) requirements.

You Will

The Network Compliance Auditor-FSR Nurse conducts Facility Site Reviews (FSR) consistent with Department of Health Care Services (DHCS) requirements, reports results and recommendations to the SCAN Network Performance Committee (NPC), provides education and support to providers to ensure compliance standards are met; including medical record reviews.

Prepares detailed written results of oversight audits by communicating findings, areas of concern and recommendations for improvement, including corrective action requests in accordance with P&P’s. An example of the type of audit report to be written would be for the SCAN’s network providers’ sites to ensure facility sites are compliant with all regulatory and SCAN requirements.

Conducts closing meetings with provider sites to provide a preliminary overview of completed compliance audits and findings. Respond to FDRs as disagreements with audit findings arise. Communicates regulation interpretations and explains their application. Provides supplemental information if needed.

Functions as the FSR compliance subject matter expert by representing the Delegation Oversight Unit (DOU) in interdepartmental meetings and partnering with Compliance to develop and implement SCAN policy regarding regulatory revisions. Escalates longstanding issues of non-compliance in accordance with P&P’s.

Educates FDRs, SCAN staff and Compliance Auditors on such topics as FSR delegated requirements in accordance with local state and SCAN contractual requirements.

Reviews FSR processes with regulatory and contractual requirements, and recommends delegated status based on results. Ability to recognize and communicate areas for improvement to the FDR enabling them to meet FSR compliance standards.

Makes revisions and recommendations for improvement of policies and procedures, as well as work flow charts for the DOU.

Assists providers in achieving and maintaining compliance with SCAN, Federal, State and NCQA requirements and guidelines including the development and implementation of corrective action plans (CAP), monitoring CAP activities and providing education and tools exercising clinical judgment.

Conducts detailed review, analysis, and interpretation of legislative, statutory, regulatory, and contract language.

Using critical thinking skills, identifies impactful areas for UM compliance to develop an effective implementation communication plan.

Assists and participates in regulatory audits, including preparation and monitoring of any CAPs.

Utilizes department desktop procedures, workflows, job aids and training material. Identifies barriers and brings to the attention of the supervisor/manager.

Maintains the member‘s right to privacy and protects SCAN operations by keeping information confidential.

Adheres to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes

Contributes to team effort by accomplishing related results as needed.

Actively support the achievement of SCAN’s Vision and Goals.

Other duties as assigned.

Your Qualifications

Bachelor’s degree in Nursing or related field required

Registered Nurse required (current and active California license in good standing)

2 years of clinical experience (medical/surgical, adult/pediatric ICU, acute care).

IPA, Medical Group experience preferred.

2 years of case management/managed care experience preferred.

Certification to conduct DHCS FSRs preferred.

Basic knowledge of related NCQA standards, CMS and DHCS regulations preferred.

Excellent written and verbal communication skills.

Strong independent analytical, critical thinking, problem solving, and decision making skills.

Strong attention to detail and organizational skills.

Strong customer service skills.

Ability to prioritize multiple and competing tasks in a fast paced environment.

Must be able to work independently as well as in a team environment.

Strong contract interpretation skills.

Travel 50 % of the time in the assigned area- Must have a valid driver’s license, automobile insurance and reliable transportation.

What's in it for you?

• Base salary range: $38.61 to $61.78 / hour
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Ten paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)