Southern Nevada Black Nurses Association
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Clinical Services Auditor (RN)

Midvale, UT

Details

Hiring Company

TAO Staffing

Positions Available

Full Time

Salary Information

$72,000 / year


Position Description

Describe how this position fits in your organization.

This role is responsible for auditing the Case Management and Utilization Management teams, to ensure we are meeting all NCQA, State, and Federal regulations for Case Management and Utilization Management. This is a crucial position for maintaining compliance with Medicaid and Medicare.

What are the 3-4 non-negotiable requirements on this position?

Must have some Case Management or Utilization Management experience Must have clinical auditing experience of some kind. Ideally, would have experience auditing case management or utilization management charts against set criteria/standards, but could also be HEDIS reviews, reviewing charts in SNF or LTC facilities, etc. Some Managed Care experience\

What are the nice-to-have skills?

Health Plan / Health Insurance Company experience; Managed Care experience Experience participating in process improvement Formal feedback experience; working with department managers to provide results of audits



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