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Utilization Management Auditor Jobs in Oregon (NOW HIRING)

Adventist Health

Chart Auditor (Portland)

Portland, OR · On-site

Adventist Health Portland is looking for Chart Auditor for Full-time, Day Shift. We are looking for ... Collaborates with Case Management, Utilization Management, Coding, Medical Officer, and Physician ...

Adventist Health

Chart Auditor (Portland)

Portland, OR · On-site

$52.55 - $78.77/hr

Adventist Health Portland is looking for Chart Auditor for Full-time, Day Shift. We are looking for ... Collaborates with Case Management, Utilization Management, Coding, Medical Officer, and Physician ...

Patientco

OR

Produces and updates guidelines and documentation of test Bachelor's Degree or equivalent in Nursing (RN) 5+ years of experience in utilization management and/or clinical documentation and auditing ...

Crew Career Center

OR

Produces and updates guidelines and documentation of test Bachelor's Degree or equivalent in Nursing (RN) 5+ years of experience in utilization management and/or clinical documentation and auditing ...

Patientco

OR

... client utilization management teams and provide feedback regarding record review and education ... auditing clinical documentation Self-starter, who is extremely motivated to demonstrate success ...

Crew Career Center

OR

... client utilization management teams and provide feedback regarding record review and education ... auditing clinical documentation Self-starter, who is extremely motivated to demonstrate success ...

Performant

Medical Review Nurse II - SNF/MDS

OR · On-site +1

Auditing claims for medically appropriate services provided in both inpatient and outpatient ... Experience with utilization management systems or clinical decision-making tools such as Medical ...

Cotiviti

Sales VP, Pharmacy Claim Editing Solutions

... claims auditing . * Represent Cotiviti at pharmacy related conferences, industry forums, and ... Proven success selling pharmacy claim editing, payment accuracy, utilization management, or related ...

Freseniusglobal

OR

$140K - $165K/yr

... utilization logic, unit conversions - ensuring the organization pays only on validated, contract ... Set risk-based cadence and audit plan; manage auditor relationship; define scope, sampling, and ...

Bryant Park Consulting

OR · On-site

... utilization management, and forecasting and reporting accuracy. You will serve as a key member of ... Manage all high-level relationships with auditors, banks, external advisors, and internals * Team ...

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Utilization Management Auditor information

What are the key skills and qualifications needed to thrive as a Utilization Management Auditor, and why are they important?

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 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 is the difference between Utilization Management Auditor vs Utilization Review Nurse?

AspectUtilization Management AuditorUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications like CCM or CUCLicensed Registered Nurse (RN), often with additional certifications
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinics, insurance companies, often in clinical settings
Primary FocusAuditing and reviewing utilization data for compliance and cost managementAssessing 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 Oregon? For Utilization Management Auditor jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Utilization Management Auditor jobs in Oregon look for? The top searched job categories for Utilization Management Auditor jobs in Oregon are:
What cities in Oregon are hiring for Utilization Management Auditor jobs? Cities in Oregon with the most Utilization Management Auditor job openings:
Utilization Management Auditor jobs near you
Clinical Product Consultant - Utilization Management

Clinical Product Consultant - Utilization Management

Patientco

On-site, Remote

Other

Medical, Retirement, PTO

Posted 4 days ago

Job description

ABOUT THIS POSITION

The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical insight into product development and testing as well have an active role in implementation and delivery of the product, interacting with customer end users and managers. The Consultant will be responsible for ensuring that the complexity of our AI technology is married with the clinical perspective and needs of our clients through data analysis and auditing. They will also be responsible for end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in the delivery of AwareUM to our clients.

WHAT YOU'LL DO

  • Collaborate with the product and services teams to execute our strategic plan for AwareUM.

  • Audit for product accuracy and effectiveness, communicating with product for change as identified

  • Assess effectiveness of AwareUM technology in creating efficient workflow for UM nurses

  • Deliver on go-forward product milestones balancing client requests with investment in new capabilities that deliver on the vision for the product

  • Collaborate with the UM growth team and support a smooth sales delivery process that results in achievement of targeted growth expectations

  • Collaborate with the CX team to create a seamless, integrated, and consistent user experience

  • Actively manage the client experience to deliver on implementation milestones, manage client support requests and expectations and monitor client successful use of the product


WHAT YOU'LL NEED

  • Bachelor of Science in Nursing (BSN) or equivalent (with RN licensure)

  • 8+ years of clinical experience in acute care setting

  • 2+ years of experience in utilization management

  • Knowledge and understanding of Utilization Management, Quality Management, Care Management, and/or Chronic Condition Management within hospital systems, post-acute providers, and/or payers.

  • Demonstrates an understanding of evolving reimbursement models, including commercial payers, Medicaid, and Medicare.

  • Demonstrates an understanding of CMS and payer regulations as it pertains to patient status and care management

  • Works effectively on a multidisciplinary team.

  • Demonstrates flexible, positive, clear interpersonal and communication skills with ability to facilitate the exchange of information with internal and external clients

  • Ability to work remotely, effectively, and efficiently

  • Proven history of collaborative, team-focused approach

  • Excellent oral and written communication skills

  • Ability to travel 20-50% of the time, to domestic locations for client or business meets. Preferred Requirements:

  • Experience leading a Utilization Management team in an acute care setting

  • Active and current Utilization and/or Case Management Certification

  • 2-3 years' experience with MCG and/or InterQual products and services.

  • Experience in the software training and education for health-care related products preferred

  • Knowledge of core software applications including google, excel, power point

ABOUT WAYSTAR

Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.

Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers. We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful,optimistic & fun.

Waystar products have won multiple Best in KLAS or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book surveys since 2012. The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystar.comor follow @Waystaron Twitter.

WAYSTAR PERKS

  • Competitive total rewards (base salary + bonus, if applicable)
  • Customizable benefits package (3 medical plans with Health Saving Account company match)
  • We offer generous paid time off for our non-exempt team members, starting with 3 weeks +13 paid holidays, including 2 personal floating holidays. We also offer flexible time off for our exempt team members + 13 paid holidays
  • Paid parental leave (including maternity + paternity leave)
  • Education assistance opportunities and free LinkedIn Learning access
  • Free mental health and family planning programs, including adoption assistance and fertility support
  • 401(K) program with company match
  • Pet insurance
  • Employee resource groups

Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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