Utilization Management Auditor - Remote

Overview

The Utilization Management Auditor plays a critical role in ensuring the accuracy, compliance, and effectiveness of the Utilization Management (UM) processes within the health plan.

In Short

• Audit Utilization Management processes for compliance and accuracy.
• Evaluate cross-departmental workflows and identify systemic issues.
• Compile detailed reports of audit findings.
• Ensure audits align with compliance requirements.
• Collaborate with various departments to resolve audit findings.
• Stay informed on healthcare regulations and best practices.
• Provide training and guidance to improve UM processes.
• Identify opportunities for process improvement.
• Maintain clear records of audit results.
• Participate in quality assurance activities.

Requirements

• High school diploma or GED required.
• Bachelor’s degree in relevant field preferred.
• Certification in Healthcare Compliance or similar is desirable.
• 3-5 years of experience in healthcare operations or auditing.
• In-depth knowledge of UM processes and regulations.
• Strong analytical and critical thinking skills.
• Excellent attention to detail.
• Strong communication skills.
• Proficiency in audit management tools and MS Office.
• Ability to manage multiple priorities in a fast-paced environment.

Benefits

• Opportunity to work in a people-first environment.
• Engagement in continuous improvement initiatives.
• Collaboration with various departments.
• Support for ongoing training and development.
• Ability to impact healthcare quality and compliance.