Kern Family Health Care · 7 hours ago
Clinical Auditor and Trainer RN
Bakersfield, CA
Full-time
Onsite
Mid, Senior Level
$45.02/hr - $57.41/hr
5+ years expKern Family Health Care is dedicated to improving the health status of its members through an integrated managed health care delivery system. The UM Auditor and Trainer RN is responsible for reviewing Utilization Management policies, performing audits, and training clinical staff to ensure compliance and improve operational efficiency.
Health CareHospitalNon Profit
Responsibilities
Maintains knowledge of covered benefits for all programs
Shares information as necessary with appropriate UM Clinical Staff, Population Health Management and Health Education, Quality Improvement, Enhanced Care Management or Community Support Services
Keeps current with California Children’s Services benefits and guidelines for coordination of services
Train other UM staff as appropriate regarding use of all platforms as it relates to UM processes
Maintain an effective, efficient, and confidential filing system both manual and electronic to allow easy retrieval and re-filing of department information
Develop and implement staff training for new and existing employees
Responsible for written and verbal communication to promote timely coordination of care and dissemination of KHS policies and procedures
In coordination with the UM Auditor and Analyst, perform audits of performance of UM Clinical Intake Coordinators and summarize and report the results of the audit to UM Management for process improvement
Perform periodic audits of inpatient and outpatient clinical decisions for appropriateness and accuracy of documentation
Assists in data collection and compilation, of various committee and quarterly reports
Maintains the confidentiality of records and reports for both the membership of KHS and the contract providers
Promote coordination with KHS Medical Director(s), Pharmacy and other departments and community partners, as appropriate, in making sound clinical decisions
Summarize and prepare necessary production reports for management
Performs other job-related duties as required
Adheres to all company policies and procedures related to employment and job Responsibilities
Qualification
Required
Registered Nurse with an active, current, unrestricted California license
Minimum of two (2) years full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required
Minimum of three (3) years' experience in utilization review required
Preferred
Bachelor's Degree from an accredited school or equivalent in Nursing, Nursing Education, Health Administration, or related healthcare field is strongly preferred
Prior experience in providing training, education, and auditing preferred
Company
Kern Family Health Care
Kern Health Systems, known as Kern Family Health Care, was established in 1993 as a managed care health plan, and is the largest health plan in Kern County.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Emily Duran
Chief Executive Officer
Alan Avery
Chief Operating Officer
Recent News
2025-01-07
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