Medical Management Auditor - UM Medical ManagementLatham, New York Apply Now Job ID 009ZS Category Medical Management Organization Fidelis Care Schedule Full-time
Position Purpose: Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes
· Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem
· Develop and maintain the audit schedule
· Audit staff as outlined in the system auditing policies
· Train audit staff at the health plan in the use of audit process and tools
· Facilitate compliance with the auditing process
· Act as a consultant related to system auditing to others in the unit, department and health plan
· Work with staff to identify and resolve authorization load error report system problems
· Coordinate auditing outcomes with the Trainer to identify, develop and publish corrective actions/educational material related to audit errors
· Coordinate auditing outcomes and system maintenance with the Sr. Clinical Systems Specialist to resolve or enhance clinical systems
·Ability to travel
Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years of related experience.
License/Certification: Current state nursing license.
For Sunshine State Health Plan & Fidelis Care only: State unrestricted license as Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Registered Nurse (RN), or Licensed Psychologist (Ph.D. or Psy.D.)
*Registered Nurse license strongly preferred.
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