Nurse Auditor Jobs

About The Position

Requirements

• LVN (Licensed Vocational Nurse) experience.
• Experience in Utilization Management.
• Experience in Delegation Oversight.
• Experience in auditing.
• Strong organizational skills.
• Proficiency in tracking and data entry.
• Ability to identify root causes of problems.
• Experience in monthly reporting and data analysis.
• Familiarity with continuous quality improvement principles.
• Understanding of Utilization Management compliance.

Nice To Haves

• Experience reporting to a Manager of UMDO.

Responsibilities

• Organization, tracking, and data entry of IPA Utilization Management audits, issues, complaints, and monitoring.
• Identify root cause of problems.
• Maintain monthly reporting that tracks and compares patterns of delegated entities.
• Assist in maintaining continuous quality improvement in the Utilization Management Delegation Oversight Clinical Audit.
• Ensure departmental and organizational goals are accomplished through oversight and facilitating Utilization Management compliance of the Plan Partners.

Benefits

• Leadership development opportunities
• Opportunities for personal, professional, and financial growth
• Supportive workplace environment
• Recognition as a U.S. News Best Company to work for
• Recognition as a Deloitte U.S. Best Managed Company
• Recognition as a Top 100 Inspiring Workplace
• Recognition by Fair360 as a Top Regional Company
• Recognition as one of the 50 most community-minded companies in the United States