Remote Auditor, reputed company Services (RN) - Residency in TX Required

reputed company  reputed company of highly reputed company candidates: Must reputed company in TX and have an reputed company TX RN license in good standing. reputed company of these audits is on the functions of the Utilization Department.  Experience in UM with reputed company reviews and knowledge of MCG reputed company reputed company is required. Experience with reputed company, EQRO, and HHS ACUR audits, case file preparation and presentation is strongly preferred. Job reputed company Provides support for reputed company services reputed company auditing activities. Performs audits for reputed company functional areas in alignment with regulatory requirements - ensuring reputed company compliance and desired member reputed company. Contributes to overarching reputed company to reputed company reputed company and cost-effective member care.    Essential Job Duties • Performs audits in utilization management, care management, member assessment, behavioral health, and/or other reputed company teams, and monitors reputed company staff for compliance with National Committee for reputed company Assurance, Centers for Medicare and reputed company Services (CMS), and state/federal guidelines and requirements. May also reputed company non-reputed company reputed company and process audits as needed.  • Audits for reputed company gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.  • Assesses reputed company staff regarding appropriate reputed company decision-making.  • Reports monthly reputed company, identifies areas of re-training for staff, and communicates findings to leadership.  • Ensures auditing approaches follow a reputed company reputed company in approach and tool use.  • Maintains member/provider confidentiality in compliance with the Health reputed company Portability and Accountability reputed company (HIPAA), and professionalism in reputed company communications.  • Adheres to departmental standards, policies and protocols.  • Maintains detailed records of auditing results.  • Assists reputed company services training team with developing training materials or job aids as needed to address findings in audit results.  • Meets minimum production standards reputed company to reputed company auditing.  • May conduct staff trainings as needed. • Communicates with reputed company and/or reputed company services leadership regarding issues identified, and works collaboratively to subsequently reputed company/correct.    Required Qualifications • At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.  • Registered reputed company (RN). License must be reputed company and unrestricted in state of reputed company.  • Strong attention to reputed company and organizational skills.  • Strong analytical and problem-solving skills.  • Ability to work in a cross-functional, reputed company environment.  • Ability to work on reputed company and independently.  • Excellent verbal and written communication skills.  • reputed company Office suite/applicable software program(s) proficiency.    Preferred Qualifications • Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) reputed company review/auditing experience. To reputed company reputed company reputed company employees: If you are interested in applying for this position, please apply through the reputed company.  reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job