RN Clinical Auditor- Bakersfield 1.1

Location: Bakersfield, CA 93309 (Hybrid Remote)
 

Classification: 

Full-Time (Non-Exempt)

Benefits:

· Medical 

· Dental 

· Vision

· Simple IRA Plan

· Employer Paid Life Insurance

· Employee Assistance Program

Compensation:

The initial pay range for this position upon employment commencement is expected to be between $96,408.00 and $120,494.4 annually, translating to $46.35 to $57.93 per hour. However, the base pay offered may be adjusted based on individualized factors, including the candidate's education, certifications, skills, and experience. We value exceptional talent and strive to provide competitive compensation packages tailored to attract and retain top candidates like yourself.

Position Summary:

The RN Auditor for the Enhanced Care Management (ECM) Program is responsible for

providing clinical oversight in compliance with the Department of Health Care Services (DHCS)

requirements. This role ensures the accuracy, completeness, and regulatory compliance of

member charts, assessments, care plans, and care activities within the ambulatory case

management setting. The RN Auditor plays a key role in supporting continuous quality

improvement, ensuring adherence to ECM program protocols, and fostering interdisciplinary

collaboration to deliver high-quality, patient-centered care for Medi-Cal beneficiaries.

Job Duties and Responsibilities:

• Perform detailed audits of member charts to ensure documentation meets DHCS, Health

Plans, and internal policy standards for accuracy, consistency, and completeness.

• Ensure care plans and assessments reflect appropriate interventions and comply with

ECM program protocols and state guidelines.

• Identify documentation or care coordination gaps, providing timely feedback to care

management and leadership team.

• Review and approve initial and ongoing assessments and care plans developed by case

managers, care coordinators, and interdisciplinary teams.

• Ensure all care plans are aligned with patient needs, goals, and DHCS requirements,

adhering to high clinical standards and ECM program guidelines.

• Oversee compliance with all local, state, and federal regulations, including Medi-Cal

ECM program requirements.

• Assist in preparing the program for external regulatory audits conducted by health plans

or other governing bodies.

• Provide licensed clinical oversight to ensure that all care coordination and case

management services comply with DHCS’s ECM program standards.

• Ensure that documentation and care planning meet DHCS requirements for quality and

regulatory compliance, including appropriate care interventions for high-need Medi-Cal

beneficiaries.

• Collaborate with ECM leadership to implement continuous quality improvement

initiatives based on audit findings.

• Ensure corrective actions are taken when gaps in care coordination or documentation are

identified and report these improvements to the ECM leadership team.

• Work closely with interdisciplinary teams, including social workers, case managers, and

healthcare providers, to ensure a coordinated, high-quality care approach in line with

ECM program goals.

• Communicate audit findings and trends, providing actionable recommendations for

process improvements.

• Collect, analyze, and report data from audits to track performance metrics, identify

trends, and highlight areas for improvement.

• Generate reports summarizing audit findings and actionable insights, sharing these with

ECM leadership for continuous program enhancement.

• Provide regular RN oversight on high acuity cases, which may include assessing high

acuity members to identify gaps in care and developing a care plan to address their

complex needs.

• Other duties as assigned.

Qualifications:

• Current, unrestricted Registered Nurse (RN) license in California.

• Bachelor of Science in Nursing (BSN) or higher degree preferred

• Minimum of 3-5 years of clinical nursing experience, with at least 2 years in case

management, care coordination, or auditing roles.

• Prior experience working in Enhanced Care Management (ECM) or managed care

programs is highly preferred.

Skills and Abilities:

• In-depth understanding of Medi-Cal ECM program requirements and DHCS

documentation standards.

• Ability to critically analyze clinical documentation and ensure regulatory compliance.

• Strong organizational skills, attention to detail, and ability to communicate findings

effectively.

• Excellent verbal and written communication skills for providing feedback to

interdisciplinary teams.

• Proficiency in electronic health records (EHR) systems and data analysis tools.

• Exceptional communication and interpersonal skills, with the ability to build and

maintain relationships with diverse stakeholders.

• Ability to maintain a high level of accuracy and attention to detail to perform each

essential duty satisfactorily.

• Ability to read and interpret documents such as policy guides, operating and maintenance

instructions, and policy and procedure manuals.

• Ability to write routine reports and correspondence.

• Ability to communicate effectively with other employees, health plan representative,

clients, vendors, and customers.

• Ability to apply common sense understanding to carry out instructions furnished in

written, oral, or diagram form. Ability to deal with problems and exercise sound

judgment involving several concrete variables in standardized situations.

• Knowledge of: Current principles, techniques and procedures used in professional

nursing; medical terminology and patient care routine appropriate to clinical setting;

community resources available to provide patient care and follow-up; federal, state and

local laws and regulations governing professional aspects of nursing.

• Understanding of and sensitivity to multi-cultural community.

• Understanding and knowledge of self-management philosophies and practices, especially

as they relate to chronic medical conditions.

• Proficiency in data interpretation and demonstrates the ability to learn new information

systems and software programs.

• Required attention to detail, analytical thinking skills, excellent technical, interpersonal,

and oral communication skills.

• Must be able to work as a member of a highly autonomous team, executing job duties and

as an independent team.

• Proficiency in creating professional documents with proper grammar and punctuation.

• Ability to maintain professionalism and adapt to a changing environment.