Utilization Management Auditor Jobs in Michigan (NOW HIRING)

Registered Nurse

Looking for Utilization Management AND Education experience.

Scope of work:

In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral Health, Care Management, and Utilization Management departments. Stakeholders include staff, physicians, department leadership, and third-party vendors. Uses specific age and culture-related physical, intellectual, psychological, and development attributes in the educational plans for staff. Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with matrix reporting to other areas in Medical Management.

• Develops/implements the educational plan for Behavioral Health, Care Management, and Utilization Management.
  Develops/implements orientation of new staff which is comprehensive and individualized with one-on-one training for three or more weeks.
  Rounding and telephonic support of staff education needs and problem solving.
  Ongoing education based on analysis of outcomes from external audits.
  Education and support for implementation and ongoing use of new electronic medical record system and supplemental ancillary computer systems.
  Collaborate with educators to Provide education and support as needed.

• Conducts department-specific assessment for educational needs related to Compliance Monitoring and Education.
  Monthly auditing of Compliance Risk areas and identification of staff education and documentation needs to ensure compliance
  Annual education on InterQual criteria changes with annual Interrater Reliability Assessment.
  Analyze and evaluate the effectiveness of all educational activities.

• Conducts educational workshops to medical management and related audiences as requested.
  Education of changes and payor requirements to targeted Physician groups.

• Develops informational materials and/or other media to be distributed to internal/external customers.
  Internal/external orientation material.
  Maintains and updates repositories of educational content needed for staff orientation, day-to-day operations, and continuing education on Sharepoint sites.
  Develops annual education plan to ensure Care and Utilization management staff have access to current best practice and relevant updates.
  Monthly auditing for specific areas of focus as directed by leadership, to ensure adherence to clinical best practice.
  

• Department Liaison for external audits.
  Coordinates and facilitates with other departments to ensure readiness for audits
  Analyze audit recommendations
  Reporting outcomes and development/implementation of staff education as needed.
  Assists with project and program improvement efforts

Qualifications

• Required Bachelor's Degree

• Preferred Master's Degree

• Utilization Management experience highly preferred.

• Education and/or training experience highly preferred

• 3 years of relevant experience Must have 3 to 5 years' experience in Care Management, or Utilization Management. Required

• Registered Nurse (RN) - State of Michigan Upon Hire required

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

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