Medical Management - Clinical Auditor & Trainer 145-2034

Community Care • Tulsa, OK

1d

About The Position

This role is responsible for developing, implementing, monitoring, and evaluating ongoing training programs and establishing a quality assurance program for Medical Management. The individual will assist the Medical Management Supervisor with training clinical staff, identify training opportunities through quality audit reviews, and incorporate training into daily stand-ups, team, and monthly staff meetings. Key duties include performing quality reviews on operational data entry for clinical personnel and selecting data criteria for Medical Management in relation to regulatory requirements.

Requirements

• Ability to assess situation, consider alternatives and choose the appropriate course of action.
• Ability to reason logically and to use good judgment when interpreting materials or situations.
• Knowledge of managed care and associated group benefit plans.
• Proficient in Microsoft applications.
• Successful completion of Health Care Sanctions background check.
• Ability to organize time effectively and set priorities.
• Possess strong oral and written communication skills.
• Graduation from accredited School of Nursing.
• Current, active, unrestrictive license to practice as Registered Nurse (RN) in the State of Oklahoma.
• At least three years of clinical nursing experience in an acute care setting.

Nice To Haves

• Certified Internal Auditor (CIA) or Certified Healthcare Compliance (CHC) preferred; or ability to obtain within 24 months of employment.

Responsibilities

• Establish training needs for data entry errors identified during the quality review audit process.
• Oversee, train and mentor new employees during training program.
• Monitor and audit mechanisms and controls to ensure appropriate data entry of authorizations, accurate and timely turn around, and accurate authorization production in accordance with established departmental policy and procedures.
• Plan, organize, develop and implement a comprehensive training program to provide staff with current techniques and information relative to their assignments and updates as appropriate.
• Responsible for department monitoring activities and uploading activities in Service Now.
• Evaluate documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines and assess clinical staff regarding appropriate decision making.
• Perform other job-related duties.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 101-250 employees