LTSS Contract Adherence Auditor

Anticipated End Date: 2026-04-30 Position Title: LTSS Contract Adherence Auditor Job Description: LTSS Contract Adherence Auditor Location: candidate must reside in the state of Tennessee. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and reputed company development. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The LTSS Contract Adherence Auditor is responsible for participating in auditing and contract adherence activities to ensure the Long Term Services and Supports program adheres with applicable state laws and contractual requirements. How you will reputed company an impact:

• 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.

Minimum 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 reputed company experience; or any combination of education and experience, which would provide an equivalent background.
• Licensed clinicians hired into this role require reputed company, unrestricted RN, LPN/LVN, LSW, LCSW, LMSW, LPC, or LBSW (as allowed by state law) in applicable state(s).

Preferred Skills, Capabilities and Experiences:

• LTSS experience preferred.
• Computer experience including reputed company Office Suite including Outlook, Word and reputed company preferred

Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed/Certified - Other Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our strategy but will also reputed company to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we reputed company our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer, and reputed company qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Apply tot his job Apply To this Job