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Registered Nurse Auditor

Siri InfoSolutions Inc. Oakland Full-Time
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Job Title: Registered Nurse Auditor

Location: 1411 E. 31st St. Oakland, CA 94602

Contract Duration: 6 Plus months

 

Job Description:

Client is looking for a local Utilization Review Auditor. The candidate would like this person to have an RN for past clinical knowledge, but there will be no patient care with this role.

 

Skill Set:

·         Acute care experience – minimum of 3 years’ experience in care management or utilization review

·         Prior Audit  experience ( for example)

·         Medical Management –  medical group delegation audits

·         CMS / Noridian –

·         Knowledge of medical necessity documentation

·          Knowledge  InterQual criteria and proficient using electronically

·         Proficient with Data Collection / Presentation

·         Knowledge of  CA -Title XXII , CMS  COP , Medicaid Benefit Coverage , Prior Authorizations

·         Preferred: Certification – ACM –CCM- CPHQ

·         Microsoft Office – competent skill set and proficient

·         Proficient with electronic medical record ( EPIC, Cerner, Meditech)

·         Preferred experience with MIDAS

·         Fast learner and can work in a fast pace environment

 

Duties:

·         Assist manager in auditing for  Adherence to UM workflow

·         Apply tool daily

·         Weekly Report

·         Train on best practice / develop algorithm / process path

·         Escalation -  denials ,  delay , Certification documentation

·         Identify bottlenecks

·         Daily reporting to manager

·         Develop Corrective Action Plan

Location

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$78K
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