Network Compliance Auditor, FSR – RN

SCAN

. Perform and provide oversight for the Managed Care Plan’s DHCS auditing team .

Posted 9/29/2026full-timeRemote • California • United StatesJuniorMid-Level💰 $39 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing and compliance within managed care, with a focus on regulatory standards and provider oversight. Proficient in conducting audits, developing corrective action plans, and ensuring adherence to DHCS, CMS, and NCQA requirements.

Highest-signal resume keywords

Registered Nurse License (RN)Auditing ExperienceDHCS-CSR CertificationRegulatory ComplianceAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ExperienceAudit DocumentationData AnalysisRegulatory InterpretationCorrective Action PlansFacility Site ReviewsMedical Record ReviewsCompliance MonitoringProject CoordinationData Entry

Soft Skills

Communication SkillsInterpersonal SkillsProblem-Solving SkillsAttention to DetailOrganizational Skills

Tools & Technologies

MS OfficeCompliance Tools

Certifications & Qualifications

Registered Nurse License (RN)DHCS-CSR Certification

Industry Keywords

Managed CareDHCSCMSNCQAMedi-MediAudit OversightProvider ComplianceLegislative ReviewContractual RequirementsQuality Standards

About the role

Key responsibilities & impact

Perform and provide oversight for the Managed Care Plan’s DHCS auditing team
Conduct and oversee initial and subsequent reviews of Primary Care Provider sites, including Facility Site Reviews and Medical Record Reviews
Complete monthly audit assignments within established timelines with thorough, compliant documentation
Review, analyze, and interpret DHCS All Plan Letters, legislative, statutory, regulatory, and contract language
Develop implementation and communication plans for regulatory compliance and provider data requirements
Audit SCAN-contracted and collaborative PCP offices serving Medi-Medi members under CMS, DHCS, and contractual requirements
Provide auditing and post-audit documentation training, feedback, and improvement recommendations
Conduct closing meetings and provide preliminary overviews of compliance audit results
Support providers with corrective action plans, CAP monitoring, education, and compliance tools
Respond to provider disagreements with audit findings and analyze submitted reports and correction requests
Explain regulation interpretations and their application
Conduct annual oversight projects, correspondence, project coordination, delegated compliance monitoring, status reporting, and regulatory update coordination
Represent the Delegation Oversight Unit as a service delivery compliance subject matter expert
Partner with Compliance on SCAN policies related to NCQA, DHCS, CMS, and other regulatory revisions
Escalate longstanding non-compliance issues and identify barriers for supervisors/managers
Educate providers on delegated claims processing and denial of claims involving member liability
Review delegated administrator letters, Compliance Program processes, and data submissions for accuracy and compliance
Maintain member privacy and confidential information
Adhere to quality, compliance, and regulatory standards
Support SCAN’s vision and goals and perform other duties as assigned

Requirements

What you’ll need

Registered Nurse License (RN) required (current and active California license in good standing)
2+ years clinical experience, including but not limited to ER/Acute Care nursing
Associate's Degree in Nursing
DHCS-CSR (certified site reviewer) preferred
Prior auditing experience preferred
Ability to work independently and in a team environment
Beginning to working knowledge of the subject matter
Basic technical skills for the functional area
Basic problem-solving skills
Good communication and interpersonal skills
Analytical, critical thinking, problem-solving, and decision-making skills
Strong attention to detail and organizational skills
Ability to prioritize multiple and competing tasks in a fast-paced environment
Proficient in MS Office and data entry
Valid driver’s license, automobile insurance, and reliable transportation
Ability to drive in assigned territory and flex to other areas as assigned
Background check required

Benefits

Comp & perks

An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year
1 floating holiday
Birthday off
2 volunteer days
Excellent 401(k) Retirement Saving Plan with employer match
Robust employee recognition program
Tuition reimbursement
Equal pay and inclusive benefits
Opportunity to become part of a team that makes a difference to members and the community