$75 - $110/hr
Position Summary The Hospital Auditor is responsible for reviewing hospital (inpatient and ... Engages with client utilization management teams to provide feedback, clarify findings, and support ...
$75 - $110/hr
Position Summary The Hospital Auditor is responsible for reviewing hospital (inpatient and ... Engages with client utilization management teams to provide feedback, clarify findings, and support ...
Medical Review Nurse - Clinical Validation
La Grange, KY · On-site
$7.25/hr
Auditing claims for medically appropriate services provided for inpatient settings while applying ... Experience with utilization management systems or clinical decision-making tools such as Medical ...
Medical Review Nurse - Clinical Validation
La Grange, KY · On-site
$7.25/hr
Auditing claims for medically appropriate services provided for inpatient settings while applying ... Experience with utilization management systems or clinical decision-making tools such as Medical ...
$110 - $140/hr
Strong management and leadership skills to build a new team of employees at our new plant. * Manage ... optimum utilization. * Manage department KPI's of Safety, People, Quality, Delivery and Cost
$110 - $140/hr
Strong management and leadership skills to build a new team of employees at our new plant. * Manage ... optimum utilization. * Manage department KPI's of Safety, People, Quality, Delivery and Cost
$105 - $130/hr
... auditor requests. * Optimize asset utilization and lifecycle management, ensuring the company gets maximum value from its investments. * Continuously improve systems and processes, leveraging ...
$105 - $130/hr
... auditor requests. * Optimize asset utilization and lifecycle management, ensuring the company gets maximum value from its investments. * Continuously improve systems and processes, leveraging ...
Inventory Control Manager II
Louisville, KY · On-site
$70K - $115K/yr
... management. Business benefits of the role: * Ensuring the right product is in the right place at ... Proper utilization of information technology * Provide required documentation to customer, customer ...
Inventory Control Manager II
Louisville, KY · On-site
$70K - $115K/yr
... management. Business benefits of the role: * Ensuring the right product is in the right place at ... Proper utilization of information technology * Provide required documentation to customer, customer ...
Inventory Control Manager II
Louisville, KY · On-site
$70K - $115K/yr
... management. Business benefits of the role: * Ensuring the right product is in the right place at ... Proper utilization of information technology * Provide required documentation to customer, customer ...
Inventory Control Manager II
Louisville, KY · On-site
$70K - $115K/yr
... management. Business benefits of the role: * Ensuring the right product is in the right place at ... Proper utilization of information technology * Provide required documentation to customer, customer ...
Site Property Administrator
Fort Campbell, KY · On-site
$19 - $25.25/hr
Auditing & Reporting: * Prepare and submit required property management reports (e.g., Loss, Damage, or Destruction [LDD] reports, utilization reports, and annual inventory certifications). * Support ...
Site Property Administrator
Fort Campbell, KY · On-site
$19 - $25.25/hr
Auditing & Reporting: * Prepare and submit required property management reports (e.g., Loss, Damage, or Destruction [LDD] reports, utilization reports, and annual inventory certifications). * Support ...
KY · On-site
$19 - $25.25/hr
Auditing & Reporting: * Prepare and submit required property management reports (e.g., Loss, Damage, or Destruction [LDD] reports, utilization reports, and annual inventory certifications). * Support ...
$140 - $160/hr
This role ensures optimal utilization of yard capacity, equipment, personnel, and transportation ... Yard Drivers * Yard Management System (YMS) Clerks * Yard Auditors Additional supervisory ...
$140 - $160/hr
This role ensures optimal utilization of yard capacity, equipment, personnel, and transportation ... Yard Drivers * Yard Management System (YMS) Clerks * Yard Auditors Additional supervisory ...
$135 - $201/hr
Management Reports: Synthesize complex data sets into concise, clear quality performance reports ... Supplier Qualification & Auditing Execution * Audit Execution: Coordinate and execute assigned ...
$135 - $201/hr
Management Reports: Synthesize complex data sets into concise, clear quality performance reports ... Supplier Qualification & Auditing Execution * Audit Execution: Coordinate and execute assigned ...
$114 - $131/hr
... utilization of economic and human resources. To perform or otherwise coordinate evaluations and auditing processes to determine results of programs instituted in the areas of: annual savings ...
New
$114 - $131/hr
... utilization of economic and human resources. To perform or otherwise coordinate evaluations and auditing processes to determine results of programs instituted in the areas of: annual savings ...
New
$70 - $100/hr
... are organizations manage documentation, chart auditing, and operational workflows through ... Familiarity with chart auditing, utilization review, compliance auditing, or quality assurance ...
New
$70 - $100/hr
... are organizations manage documentation, chart auditing, and operational workflows through ... Familiarity with chart auditing, utilization review, compliance auditing, or quality assurance ...
New
$90 - $120/hr
Oversees the facility inventory auditing, reporting and reconciliation process to ensure accurate ... Optimizes the utilization of the Inventory Management Systems (Plex) within the facility; ensure ...
$90 - $120/hr
Oversees the facility inventory auditing, reporting and reconciliation process to ensure accurate ... Optimizes the utilization of the Inventory Management Systems (Plex) within the facility; ensure ...
... management decision-making. * Lead the implementation, enhancement, and effective utilization of ... Serve as the primary liaison with external auditors, banking institutions, governmental agencies ...
Quick apply
... management decision-making. * Lead the implementation, enhancement, and effective utilization of ... Serve as the primary liaison with external auditors, banking institutions, governmental agencies ...
Logistics Analyst
Louisville, KY · On-site
... utilization. Partner with inventory management team to assess fleet coverage for inbound lanes ... Auditing - Use data available from various systems to monitor process adherence in various aspects ...
Logistics Analyst
Louisville, KY · On-site
... utilization. Partner with inventory management team to assess fleet coverage for inbound lanes ... Auditing - Use data available from various systems to monitor process adherence in various aspects ...
$140 - $210/hr
Make decisions on design tool utilization and associated costs (MapInfo, Google Earth, ATOLL, and ... management, drive testing data analysis, network optimization, network quality auditing, network ...
$140 - $210/hr
Make decisions on design tool utilization and associated costs (MapInfo, Google Earth, ATOLL, and ... management, drive testing data analysis, network optimization, network quality auditing, network ...
$120 - $145/hr
Serve as the Power Platform Administrator, managing environments, tenant settings, licensing ... Experience with Microsoft Purview, including information protection, retention, auditing, and other ...
New
$120 - $145/hr
Serve as the Power Platform Administrator, managing environments, tenant settings, licensing ... Experience with Microsoft Purview, including information protection, retention, auditing, and other ...
New
Quality Technician
Louisville, KY · On-site
$17.25 - $23.25/hr
... linen management control system that measures and monitors linen utilization by department to ... ISO 9001:2015 internal auditing or quality systems training preferred. * Experience in healthcare ...
Quality Technician
Louisville, KY · On-site
$17.25 - $23.25/hr
... linen management control system that measures and monitors linen utilization by department to ... ISO 9001:2015 internal auditing or quality systems training preferred. * Experience in healthcare ...
Quality Technician
Louisville, KY · On-site
$17.25 - $23.25/hr
... linen management control system that measures and monitors linen utilization by department to ... ISO 9001:2015 internal auditing or quality systems training preferred. * Experience in healthcare ...
Quality Technician
Louisville, KY · On-site
$17.25 - $23.25/hr
... linen management control system that measures and monitors linen utilization by department to ... ISO 9001:2015 internal auditing or quality systems training preferred. * Experience in healthcare ...
Logistics Analyst
Louisville, KY · On-site
... utilization. Partner with inventory management team to assess fleet coverage for inbound lanes ... Auditing - Use data available from various systems to monitor process adherence in various aspects ...
Logistics Analyst
Louisville, KY · On-site
... utilization. Partner with inventory management team to assess fleet coverage for inbound lanes ... Auditing - Use data available from various systems to monitor process adherence in various aspects ...
Utilization Management Auditor information
What is a utilization management auditor?
A Utilization Management Auditor is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.
What are the key skills and qualifications needed to thrive as a utilization management auditor?
To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.
What are some common challenges faced by utilization management auditors and how can they be addressed?
Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.
What is the difference between Utilization Management Auditor vs Utilization Review Nurse?
| Aspect | Utilization Management Auditor | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications like CCM or CUC | Licensed Registered Nurse (RN), often with additional certifications |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinics, insurance companies, often in clinical settings |
| Primary Focus | Auditing and reviewing utilization data for compliance and cost management | Assessing patient care needs and determining appropriate services |
While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.
What are popular job titles related to Utilization Management Auditor jobs in Kentucky?
For Utilization Management Auditor jobs in Kentucky, the most frequently searched job titles are:
What job categories do people searching Utilization Management Auditor jobs in Kentucky look for?
The top searched job categories for Utilization Management Auditor jobs in Kentucky are:
What cities in Kentucky are hiring for Utilization Management Auditor jobs?
Cities in Kentucky with the most Utilization Management Auditor job openings:
Ardent Health Services rating
6.8
Based on 144 frontline employees who took The Breakroom Quiz
498th of 893 rated healthcare providers
Job description
Overview
Position Summary
Responsibilities
Qualifications
Preferred Qualifications
#J-18808-LjbffrArdent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states.
Position Summary
The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team’s broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard reimbursement integrity, ultimately contributing to improved patient care and organizational compliance.
Responsibilities
- Conducts comprehensive record reviews to identify documentation gaps and best‑practice process improvement opportunities.
- Performs high‑level secondary case reviews to ensure accurate, complete, and compliant provider documentation.
- Assesses documentation alignment with ICD‑10‑CM/PCS, MS‑DRG/APR‑DRG, and payer guidelines, identifying missed or inappropriate diagnoses, procedures, CC/MCCs, and SOI/ROM opportunities.
- Analyzes audit findings, evaluate trends and risks, and prepare detailed reports, summaries, and presentations for internal and external stakeholders.
- Produces, maintains, and updates guidelines, processes, procedures, and documentation standards to support consistent audit practices.
- Engages with client utilization management teams to provide feedback, clarify findings, and support best‑practice improvement initiatives.
- Develops and delivers education on clinical concepts, documentation requirements, and audit findings to clients, internal teams, CDI specialists, coders, clinical staff, and product designers.
- Performs regular and ad hoc audits, reviews, and conducts investigations related to documentation quality, data integrity, and compliance.
- Utilizes audit tools, authoritative references, CMS/CPT guidelines, and statistical analyses (including bell curves) to identify trends and validate findings.
- Communicates audit outcomes effectively to providers, market leaders, and Compliance Audit Team leadership.
- Manages workload, prioritizes tasks, and takes ownership of assignments to ensure timely, high‑quality audit completion in accordance with policies, procedures, and financial regulations.
- Supports collaborative relationships with internal and external partners and demonstrate flexibility by working with other team members as needed.
Qualifications
Required Qualifications
- High School Diploma
- 3+ years MS DRG/APR DRG experience
- Epic experience.
- One of the following Coding Certifications required: RHIA, RHIT, CCS, CIC, CCDS, CDIP or CPC
- Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
- Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.
- Ability to apply clinical review judgment to make clinical determinations
- Proficient in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and virtual meeting tools i.e., Microsoft Teams, Zoom, etc.
- Strong written and oral communication skills
- Demonstrated analytical approach to problem solving.
Preferred Qualifications
- RN license
What Ardent Health Services employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Ardent Health Services
Sourced by ZipRecruiter
With 30 hospitals and hundreds of clinics, Ardent Health Services is a premier provider of health care services, delivered with compassion for patients and their families and with respect for employees, physicians and other health professionals. Nearly half of our facilities have been recognized among healthcare's best places to work.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Nashville, TN, US
Year founded
1993