LTSS Contract Adherence Auditor ensuring compliance with state laws and contract requirements. Responsible for audits, adherence tracking, and staff education within a virtual role based in Tennessee.
Responsibilities
Participating in auditing and contract adherence activities to ensure the Long Term Services and Supports program adheres with applicable state laws and contractual requirements
Prepares and ensures completion of internal and external audits, adherence reporting and tracking/monitoring processes as assigned
Audits LTSS work to ensure appropriate and consistent administration of contract requirements
Performs external audits including enrollee record review, new member and short term stay, MCO to MCO, Level of Care and Employment and Community First audits
Responds to on demand state audit requests
Responsible for Annual Quality Survey and Annual Network Audit reviews, audit participation and presents audit results
Provides internal Person Centered Support Plan auditing and comprehensive adherence auditing
Documents audit findings in a timely, accurate and concise manner
Tracks activities such as daily critical incident submissions, short term stay, Individual Experience, Employment and NCI surveys and caseload tracking
Ensures clinical licensure adherence with contract requirements
Completes monthly reports such as short term stay, caseload staffing and ratio reporting
Responds to legislative inquiries and other on demand request per contract agreement
Maintains knowledge of tracking tools and databases, and prepares reports to document contract adherence issues
May educate staff about contract requirements to ensure contract adherence
Participates in projects, initiatives and process improvement activities
May serve as an internal resource, mentor and coach for new associates
Requirements
Requires BA/BS and RN, LPN/LVN, LSW, LCSW, LMSW, LBSW, BSW, or MSW in accordance with applicable state law and minimum of 2 years related experience
Licensed clinicians hired into this role require current, unrestricted RN, LPN/LVN, LSW, LCSW, LMSW, LPC, or LBSW (as allowed by state law) in applicable state(s)
LTSS experience preferred
Computer experience including Microsoft Office Suite including Outlook, Word and Excel preferred
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