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Kaiser Permanente

Clinical Auditor VI

Career Insights for Clinical Auditor / Utilization Reviewer

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What they do

A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.

$118,997 / year median in California

-4% projected decline

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Job Description

Are you passionate about improving patient care through data, analytics, and system-wide improvement? The Clinical Audit Specialist brings clinical expertise to audits and advisory projects that evaluate patient safety, quality of care, regulatory compliance, operational performance, and the effectiveness of clinical controls across Kaiser Permanente's integrated care delivery system. Working closely with audit, quality, compliance, and clinical leaders, this role leverages electronic health records, clinical documentation, workflow analysis, and data-driven insights to identify risks, strengthen controls, improve processes, and recommend sustainable solutions that enhance patient care and operational effectiveness. Ideal candidates have clinical experience in acute care settings and a background in quality improvement, accreditation, risk management, audit, or regulatory oversight.
Job Summary:
In addition to the responsibilities listed below, this senior technical/functional leader is also responsible for conducting risk assessments and audit planning; identifying clinical risk factors; prioritizing audit areas based on patient impact, regulatory exposure, and operational priorities; providing clinical expertise; and leading clinical components of audits and advisory projects across care settings, including process walkthroughs, control design assessments, sampling and text execution.
Essential Responsibilities:
Promotes learning in others by communicating information and providing advice to drive projects forward; builds collaborative, cross functional relationships. Solicits and acts on performance feedback; provides actionable feedback to others, including upward feedback to leadership; influences, mentors, and coaches team members. Practices self-leadership; creates, evaluates, and responds to the strengths and weaknesses of self and unit or team members. Leads the adaptation to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Fosters open dialogue amongst team members. Drives the execution of multiple work streams by identifying member and operational needs; translates business strategy into actionable business requirements; develops and updates new procedures and policies. Gains cross-functional support for objectives and priorities; determines and carries out processes and methodologies; solves highly complex issues; escalates and resolves issues as appropriate; sets standards and measures progress. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; influences the completion of project tasks by others. Leads risk assessment activities by leveraging expertise in area of risks; and deciding which risk projects will be completed. Plans, schedules, and supervises assigned projects and staff in accordance with the audit plan, project budgets, and milestones; reviews and approves project level risk assessments; develops audit and project plans; approves work papers or other documentation; approves/prepares reports; and adheres to professional standards. Partners with company leaders on risk matters and acts as an internal consultant on analyzing and interpreting organizational risks and/or mitigation strategies. Develops the strategy and sets priorities for multiple client or functional areas by leveraging and engaging other members of the team; taking the lead role in driving client or functional area development based on risk assessment activities, client interactions, and industry knowledge; and directing the on-going risk assessment and audit planning process. Leads department initiatives.
Qualifications:
Knowledge, Skills and Abilities:
(Core) Ambiguity/Uncertainty Management Attention to
Detail Business Knowledge Communication Constructive Feedback Critical Thinking Cross-Group Collaboration Decision Making Dependability Diversity, Equity, and Inclusion Support Drives Results Facilitation Skills Health Care Industry Influencing Others Integrity Learning Agility Organizational Savvy Problem Solving Short- and Long-term Learning & Recall Teamwork Topic-Specific Communication Knowledge, Skills and Abilities:
(Functional)
Debugging and Troubleshooting Maintain Files and Records Managing Diverse Relationships Microsoft Excel Negotiation Organizational Skills Project Management Stress Tolerance Technical Communication Trusted Advisor Minimum Qualifications:
Bachelors degree in a clinical related field (e.g. Nursing, Pharmacy, etc.) AND Minimum ten (10) years audit or related clinical or business experience. Additional equivalent work experience in a directly related field may be substituted for the degree requirement. Minimum four (4) years project management experience. Minimum five (5) years clinical experience in a hospital or acute care setting. Minimum two (2) years of experience in one or more of the following: quality improvement, risk management, audit, or Accreditation, Regulatory and Licensing (AR&L).
Preferred Qualifications:
Master's degree in Nursing, Healthcare Administration, Public Health, Business Administration, or a related field. Registered Nurse (RN) licensed in any State.