Specialized Recruiting. Temporary Staffing. Managed Services. 800 876 2314


Manager of Internal Audit & Monitoring

Employment Type Permanent
Field of Work Clinical/Medical

 

Position Summary

The Manager of Internal Audit & Monitoring is responsible for ensuring operational compliance in accordance with applicable Regulatory, Accreditation and business requirements. This individual plays a key role in setting the strategic direction of the internal monitoring function, including development of monitoring strategies aimed at compliance issue identification and resolution, evaluating the success of corrective actions implemented and developing methods for successful issue resolution.

 

The position is accountable to leadership and key stakeholders for the overall management and assessment of internal monitoring and audit protocols, reporting of findings and proposal of solutions. Utilizing all available compliance related information, the incumbent will develop and implement the monitoring criteria, prioritize the internal audits which comprise the monitoring work plan and partner with analytics team to develop the inward/outward facing report monitoring vehicles. Position will proactively interact with internal departments, including Compliance, Policy Administration, Clinical Informatics, Medical Management and Account Management.

 

Position Responsibilities

  • In collaboration with operational leads, responsible for developing and executing the internal audit plan, with emphasis on high risk areas. Position will be accountable to recommend and to routinely monitor corrective and preventive actions.
  • Provide oversite and direction to team implementing the audit plan. Provide guidance to develop scope/purpose, audit methodology/tools, sampling plan, compliance parameters, reporting criteria and escalation pathway. Reviews completed internal audit reports and presents findings/recommendations for management/committee review.
  • Leads focused meetings with Operational areas to facilitate root cause analysis, identify deficiencies and to brainstorm appropriate remediation plans.
  • Collaborates with Compliance on the development of corrective action plans and in formulating monitoring mechanisms to measure effectiveness of the remediation(s) identified.
  • In conjunction with internal departments, develop compliance monitor reporting as well as baseline data to identify trends and outliers.
  • Facilitates appropriate corrections, up to and including identification of training needs, development of proposals for system modifications and ensuring necessary compliance and monitoring of data.
  • Responsible for managing a team with respect to hiring, mentoring, coaching, performance and discipline.
  • Completion of routine status reports, as needed.
  • Oversee additional monitoring and focused audits, as necessary.
  • In conjunction with ensuring best practices, recommend and promote opportunities for improvement within the organization.

 

Position Requirements

  • Bachelor’s degree or equivalent work experience required in either a healthcare or health plan environment. MBA/MA preferred.
  • Experience managing teams.
  • Must possess ability to collaborate with senior level staff and provide leadership to internal stakeholders regarding best business practices and continuous process improvement.
  • Strong planning and problem solving skills.
  • Strong knowledge of healthcare industry, including Utilization Management requirements, health care laws and regulatory requirements, Medicare/Medicaid/Commercial products and Accreditation standards.
  • Solid working knowledge of Utilization Management and/or Claims systems
  • Experience with implementation of corrective action programs.
  • Knowledge of tools, concepts and methodologies of audit
  • Excellent interpersonal and verbal/written communication skills
  • Data analysis, objective-thinking, judgment and leadership skills.
  • Schedule-orientated (able to consistently maintain schedules and meet deadlines).
  • Attention to detail.
  • Ability to manage multiple priorities.
  • Professional and positive commitment to service delivery.
  • MS Office Suite (MS Outlook, Word, Excel, and Power Point)
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