Medical Management Auditor Job Description:
Permanent, Full Time, M-F
***Please only apply if you are a currently licensed RN and have Auditing and/or Utilization Review experience within Managed Care/Health Plan or Acute Care settings.
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: ...
Performs the functions of pre-admission, admission, continued stay, discharge, and re-admission reviews and quality reviews against set criteria.
JOB SPECIFIC RESPONSIBILITIES
Conducts pre-admission, admission, continued stay, re-admission, and discharge reviews each working day; utilizes the physician approved Interqual quality review criteria and Medical Center Utilization Management criteria concurrently.
Provides review information to insurance companies as required to ...
The Clinician 2 has authority, responsibility, and accountability as follows:
Plan of Care/Clinical Pathways: Develops an individualized plan of care for assigned patients. Coordinates care for individual patients on a day to day basis.
Education: Accountable for teaching patients new information. Accountable for maintaining professional competencies.
Communication: Is accountable for effective communication with patients/family, care team members and physicians regarding the ...
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