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Supervises, plans and coordinates the daily operations of the Clinical Operations oversight monitoring auditors. Oversight of teams includes developing and maintaining models for tracking of staff performance. Supervises the day to day workflows including organizing, distributing and prioritizing work assignments for staff, monitoring of performance to ensure quality and accuracy and ensuring compliance with applicable regulations through internal oversight audit activities. Reviews final work product and escalates issues appropriately. Prepares summary reports for departmental leadership.

Bachelor’s degree in Social Work, Nursing, or Healthcare-related field or applicable experience in lieu of degree and 6 years relevant work experience required. Three to five years relevant supervisor experience required. Compliance oversight and/or audit experience required. Active, unrestricted State Nursing license or Licensed Independent Social Worker (LISW) or Advanced Practice Social Worker (APSW) in good standing highly preferred. Experience in utilization management, disease management, care coordination/case management, long-term care, community health and quality assurance highly preferred. Proficiency in Microsoft Word, Excel and Outlook required. Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.

*Supervises daily workflow functions related to applicable departmental activities.

*Organizes, distributes and prioritizes work assignments for staff.

*Train oversight audit staff as appropriate to complete internal and external audit activities.

*Participates in selection, training, and orientation of new employees.

*Escalates identified issues and works with manager and department leadership to develop actions plans for resolution.

*Develops, monitors, and updates internal and external corrective action plans in coordination with manager.

*Manages, conducts and maintains compliance activities to ensure they meet and satisfy regulatory requirements for NCQA, Peer Review Organizations; CMS, DOI, and other monitoring entities. Completes reports as required.

*Implements change initiatives to enhance compliance efforts. Serves as a resource, educates staff and mentors staff in applicable principles and decision-making skills.

*Develops and implements tools to measure compliance with established standards. Reviews and revises tools as standards change. Tracks and trends result. Identifies and implements opportunities for improvement.

*Coordinates and works closely with managers and other departments on all audits and audit-related projects to support and ensure consistency of practice and decision making.

*Manages preparation for accreditation and regulatory audits as assigned to include the interpretation of standards and development of mechanisms for compliance. Manages activities and prepares files and documents to support accreditation and regulatory audits for all product lines.

*Develops standards of performance, evaluates performance, and initiates or makes recommendations for personnel actions. Coordinates and acts as a resource for policies, procedures, and operational changes.

Presbyterian Healthcare Services is an integrated system of 8 hospitals, 36 clinics, a physician medical group and a health plan. As New Mexico's only private, not-for-profit healthcare system we exist to improve the health of the patients, members and communities we serve. Presbyterian is in an exciting period of innovation, and we are actively strengthening our integrated system to create high quality, efficient and affordable care for the New Mexicans we serve.

We are proud of our 103-year legacy of providing healthcare that began before New Mexico was even a state, and we know how important it is to ensure that we're here for New Mexicans today and in the future

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 10/26/2016 4:28:59 PM

Job Contact:
Margret Brown

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9521 San Mateo Blvd NE
Albuquerque, NM 87113-2237