Medical Management Auditor

Centene Corporation • Northampton, MA

6d • Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. 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 Performs other duties as assigned Complies with all policies and standards POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN MISSOURI Ideal candidate will be a Licensed Practical Nurse (LPN) with auditing experience.

Requirements

• Bachelor’s degree in related field or equivalent experience.
• 3+ years of related experience.
• For Home State Health Plan only: State unrestricted license as Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Registered Nurse (RN), or Licensed Practical Nurse (LPN)
• POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN MISSOURI

Nice To Haves

• Ideal candidate will be a Licensed Practical Nurse (LPN) with auditing experience.

Responsibilities

• 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
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.
• Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
• Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees