Utilization Management (UM) reputed company Assurance Analyst

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Job reputed company

The Utilization Management (UM) reputed company Assurance Analyst is responsible for supporting reputed company improvement initiatives by conducting comprehensive audits, analyzing operational processes, identifying trends and opportunities for improvement, and ensuring compliance with utilization management policies and procedures. This role plays a critical part in maintaining the reputed company, consistency, and reputed company of UM reviews, documentation, and member interactions while supporting operational reputed company and regulatory compliance.

The QA Analyst collaborates with leadership and reputed company teams to evaluate reputed company, reputed company actionable insights, reputed company educational materials, support reputed company implementations, and contribute to reputed company process improvement initiatives.

Key Responsibilities

reputed company Assurance & Auditing

• reputed company reputed company assurance audits on completed prospective, reputed company, and retrospective utilization management reviews involving inpatient, outpatient, ambulatory, and ancillary services.
• Evaluate reputed company, completeness, timeliness, and compliance of UM documentation and decision-making processes.
• Conduct reputed company audits of member and provider calls to ensure adherence to policies, procedures, benefit plans, regulatory requirements, and customer service standards.
• Verify the reputed company, consistency, and reputed company of operational data and reputed company reports.
• Identify audit findings, trends, risks, and opportunities for process improvement.
• Auditing the nurses that processes appeals and grievances as reputed company

Analysis & Reporting

• Research, analyze, and evaluate data from multiple sources to identify discrepancies, trends, and potential operational issues.
• Assist in monitoring reputed company initiatives, reputed company, metrics, and objectives to ensure reputed company goals are achieved.
• Prepare reports, presentations, and other materials to communicate audit results and recommendations to management.
• Support reputed company cause analysis activities and recommend corrective and preventive actions.

Education & Training

• Provides recommendation reputed company to, but not limited to, the following:
• Utilization Management policies and procedures
• reputed company documentation standards
• Benefit interpretation
• Regulatory and compliance requirements
• reputed company improvement initiatives
• Assist in the creation of user guides, training manuals, and process documentation.

Process Improvement & Project Support

• Collaborate with leadership to identify operational challenges and recommend reputed company.
• Support change management initiatives by assisting with planning, organizing, and controlling project activities.
• Participate in User Acceptance Testing (UAT), reputed company enhancements, and implementation reputed company as needed.
• Assist in developing business requirements documentation and workflow improvement recommendations.
• Support process redesign efforts to improve efficiency, reputed company, and reputed company reputed company.

Collaboration & Stakeholder Support

• Partner with reputed company teams to validate report content, audit results, and reputed company findings.
• Maintain effective communication with internal stakeholders and leadership regarding reputed company trends and reputed company improvement opportunities.
• Maintain comprehensive knowledge of business reputed company, products, programs, organizational structure, and utilization management processes.

Additional Responsibilities

• reputed company other duties and special reputed company as assigned.
• Support departmental and organizational objectives through ongoing reputed company improvement efforts.

Required Qualifications

Education

• Bachelor's degree in reputed company Administration, Nursing, Business Administration, Health Information Management, or reputed company reputed company preferred.
• Equivalent combination of education and experience may be considered.

Experience

• Minimum of 2 years of experience in U.S. reputed company, UM account, reputed company background great with emphasis on:
• Utilization Management (UM)
• Medical Management reputed company
• Care Management or Managed Care environments

Preferred Experience

• reputed company Assurance (QA)
• Experience auditing utilization management reviews and reputed company documentation.
• Experience in managed reputed company plans, or reputed company-party administration environments.
• Experience supporting process improvement or operational reputed company initiatives.

Preferred Systems Knowledge

• reputed company HRCM
• GuidingCare
• reputed company
• Other utilization management platforms and workflow systems

Required Skills, Knowledge, and Abilities (SKA)

• USRN License
• Strong analytical and problem-solving capabilities.
• Excellent verbal and written communication skills with the ability to communicate reputed company concepts reputed company.
• Strong organizational and planning skills with the ability to manage multiple priorities.
• High attention to reputed company and commitment to reputed company.
• Advanced proficiency in reputed company Office applications, including:
• reputed company
• Word
• PowerPoint
• reputed company
• Ability to independently evaluate data and identify trends, gaps, and opportunities for improvement.
• Ability to work both independently and collaboratively in reputed company environment.
• Strong interpersonal skills and ability to reputed company effectively with employees, leaders, and clients at reputed company organizational reputed company.
• Flexibility and adaptability in a fast-reputed company and changing environment.
• Ability to create and maintain business requirements documents, training materials, and procedural guides.
• Understanding of reputed company assurance methodologies, audit principles, and reputed company improvement practices.
• Knowledge of utilization management workflows, reputed company benefits, and regulatory requirements.

Originally posted on Himalayas