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Consulting Services & Project/Program Management (Non-IT)

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Senior Medicare Quality Auditor

Location: San Diego, CA Job Number: 730460 Date posted: 09/01/2018
Description:

Responsible for coordinating and supporting the effective execution of quality performance activities. Develops possible solutions to quality management issues and may design and implement processes necessary to make these changes. Coordinates the development of quality assurance performance and improvement indicators. Responsible for the identification of complex quality issues through analyzing data and preparing reports. Develops organizational and performance standards. Responsible for reporting as well as statistical analysis and recommendations.  



Essential Responsibilities:


  • A seasoned, experienced professional with a full understanding of area of specialization; resolves a wide range of issues in creative ways. This job is the fully qualified, career-oriented, journey-level position.


  • Requires planning to coordinate with other departments or resources.


  • Basic Qualifications:

    Experience
    - Minimum five (5) years of related experience required.
    Education
    - Bachelor's degree, OR four (4) years of experience in a directly related field.
    - High School Diploma or General Education Development (GED) required.
    License, Certification, Registration
    - N/A  


     

    Additional Requirements:
    - Demonstrate excellent verbal, written, and interpersonal communication skills.
    - Must be able to work in a Labor/Management Partnership environment.  

     

    Preferred Qualifications:
    - Bachelor's degree preferred.  
    - Medicare knowledge preferred.
    - Quality Auditing experience preferred.
    - Must be comfortable with 80% repetitive task of auditing and reviewing records, and 20% will be project work.
    - Must be able to participate in developing KPI's.
    - Must be able to identify, document process improvement through Work Instruction recommendations.
    - Exercise judgement within defined metrics focusing on conformance to established standards.
    - As necessary, ability to perform follow-up on assigned audit report action plans to ensure that the business partners have completed agreed upon action.
    - Experience in research processing problems and errors to determine their origin and appropriate resolution.
    - Experience in preparing reports and summarizing observations for management and making recommendations.    
     
    Primary Location: California,San Diego,California Service Center - Rio S.D. 8954 Rio San Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Consulting Services / Project/Program Management (Non IT) Department: Medicare Risk Mitigation Travel: Yes, 5 % of the Time
    Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Consulting Services & Project/program Management (non-it) Careers

    Consulting Services & Project/program Management (non-it) Careers

    These careers consist of Program and Project Managers, Business Consultants, Business Analysts, and Data Analysts who all work together to effect positive organizational change from the inside out.

    Join our talented team and make a difference through performing business analysis, developing business cases, providing client support during system development and implementation, managing projects, or by leading complex programs with multiple work streams.

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