Mosaic
Mosaic is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans.
residential • vocational • medical • spiritual • social
Clinical Auditor
February 28
🏄 California – Remote
💵 $74.2k - $111.2k / year
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔎 Auditor
🦅 H1B Visa Sponsor
Mosaic
Mosaic is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans.
residential • vocational • medical • spiritual • social
📋 Description
• Responsible for participating in clinical audit activities for Carelon Health • Conduct audits of the work done by Carelon Health nursing staff and appeals • Reviews clinical cases documentation (i.e. letters), claims history, provider information, and benefit information • Utilizes multiple sources to conduct research including mainframe applications and business standard operating procedures • Documents results and findings and provides scored results to clinical nurses and management • Prepares reports for management that define and evaluate problems and propose solutions • Handles rebuttals for assigned cases and for other clinical audit staff • Attends weekly quality meetings and participates in quarterly calibration meetings • Assists with clinical cases
🎯 Requirements
• Requires AS in Nursing • Minimum of 3 years of clinical experience in a healthcare setting • Current unrestricted RN license in applicable state(s) required • Knowledge of and experience with regulatory/accreditation standards/audits strongly preferred • BSN preferred in addition to CPHQ (Certified Professional in Healthcare Quality)
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