Centene Corporation Medical Management Auditor in Smyrna, Georgia

Description:

Position Purpose: Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes

  • Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem
  • Develop and maintain the audit schedule
  • Audit staff as outlined in the system auditing policies
  • Train audit staff at the health plan in the use of audit process and tools
  • Facilitate compliance with the auditing process
  • Act as a consultant related to system auditing to others in the unit, department and health plan
  • Work with staff to identify and resolve authorization load error report system problems
  • Coordinate auditing outcomes with the Trainer to identify, develop and publish corrective actions/educational material related to audit errors
  • Coordinate auditing outcomes and system maintenance with the Sr. Clinical Systems Specialist to resolve or enhance clinical systems
  • Ability to travel

Qualifications:

Education/Experience: Bachelor s degree in related field or equivalent experience. 3 years of related experience.

License/Certification: Current state nursing license. Valid driver s license and insurance.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Job: Quality Assurance

Organization: Peach State Health Plan

Location: Georgia-Smyrna

Requisition ID: 1049425