Hiring: Grievance and Appeals Internal Auditor Company: Partnership HealthPlan of California Location: Shasta County, CA Job Posted Time: 2026-09-03 07:38:56 Employment Type: Contract Target Skills & Keywords : Compliance About the job Required Skills: •Regularly conducts concurrent and retrospective audits of individual case investigations according to established audit criteria and provides feedback to associates as applicable •Performs routine and timely quality assurance audits for all types of cases – grievance, appeals, exempts, and State Hearing cases conducted on a standard or expedited basis •Assesses cases to determine if DHCS-mandated timeframes, NCQA specifications, and Partnership professional standards for member experience are met •Determines if clinical guidance is executed accurately throughout the case investigation process •Evaluates the quality of written communications •Assesses accurate use of reporting fields to support DHCS, NCQA, and interdepartmental reporting interests •Evaluates the appropriateness of referrals and determine if best resolution is offered given nature of case •Enters audit findings of individual cases in the audit tracking database Qualifications: •Special Skills, Licenses and Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!