Manager, Clinical Audit

Richmond VA 23233

Job Description

Provides direct oversight to a team of Clinical Auditors responsible for trending audit results, assisting with identification of additional training required to improve compliance or quality outcomes, conducting quality review and validation of state reporting as well as providing support for internal and external audits or accreditation on-sites.
  • Manages day-to-day care coordination quality and auditing activities for assigned business areas
  • Ensures programs processes, and procedures support company goals for service, quality, and cost effectiveness as well as compliance with contractual state and federal requirements
  • Assist clinical leadership in the development of strategic and operational goals and plans
  • Assists clinical leadership in the identification and coordination of the necessary clinical and client service training needs
  • Coordinates quality improvement activities under the direction of clinical leadership
  • Analyzes specific utilization problems, plans, and implements solutions that directly influence quality of care and cost initiatives
  • Supervises the collection of pertinent clinical information while maintaining a good relationship with providers
  • Partners with product owners to ensure program delivery is consistent with product features
  • Supports account management team in addressing client specific issues
  • Appropriately researches and addresses escalations and complaints from our regulatory body
  • Conducts recruitment, interviewing, and selection of properly qualified staff members and ensures appropriate orientation is provided
  • Regularly monitors the performance of staff, monitoring adherence to the performance goals and projects; provides feedback and counseling as appropriate

General Job Information

Title

Manager, Clinical Audit

Grade

27

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

7/2/2019

Date Requisition Created

6/28/2019

Work Experience

Clinical, Managed Healthcare, Medicaid, Supervisory

Education

Associates: Nursing (Required), Bachelors: Nursing, Masters: Nursing

License and Certifications - Required

RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Required Qualifications

  • Associates Degree in Nursing
  • Must be a registered nurse in the state of Virginia
  • 1-3 years supervisory experience
  • 5 years clinical experience
  • 1-3 years Medicaid managed care experience
  • 1-3 years case management experience
  • 1-3 years NCQA experience

Preferred Qualification

  • Bachelor's or Masters Degree in Nursing

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”