2 days ago
πΊπΈ United States β Remote
π΅ $69.8k - $96.2k / year
β° Full Time
π‘ Mid-level
π Senior
π Auditor
β’ Reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations β’ Conducts and summarizes compliance audits β’ Collects and analyzes data daily, weekly, monthly or as needed β’ Performs pre-service denial and quality assurance audits β’ Provides detail audit results including issues on absence of documentation, incorrect decision making, non-compliance β’ Responsible for internal and external communications to obtain needed information β’ Recommends process changes or training opportunities related to audit trends β’ Coordinates special compliance projects and additional tasks as determined by leadership
β’ Current Unrestricted Florida RN license or Compact RN License the state where you reside β’ Experience with Utilization Management and Quality assurance audits β’ Clinical experience in an Acute Care β’ Proficiency in Microsoft Office Products Word, Excel, and Power Point β’ BSN or Bachelor's degree in a related field (Preferred) β’ Bilingual (English, Spanish) (Preferred) β’ Experience as a utilization management Auditor (Preferred) β’ Health Plan experience working with large carriers (Preferred) β’ Experience working with MCG/Interqual guidelines (Preferred) β’ Microsoft Outlook (Preferred) β’ Excellent computer skills and ability to easily navigate multiple applications (Preferred) β’ Skilled and/or Rehabilitation Clinical setting (Preferred)
β’ Medical, dental and vision benefits β’ 401(k) retirement savings plan β’ Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) β’ Short-term and long-term disability β’ Life insurance β’ Many other opportunities
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