RN Nurse Auditor Global Risk Contracts Regulatory Compliance Coordinator
General Function: The Nurse Auditor is responsible for maintaining compliance and monitoring and reporting compliance issues for the functions of Complex Case Management, Disease Management , Transitional Case Management and Model of Care. The Nurse Auditor interfaces with health plans, and has oversight of health plan delegated reports. Monitoring includes review of the work of others that perform service delivery of delegated member programs and providing feedback to ensure that delegation requirements pertaining to NCQA and CMS are met. Health plan and delegate interface requires participation in external audits of CM, DM, and MOC programs, monitoring policies and procedures, and preparation and review of clinical files. Delegated reporting functions i
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