Medical Management - Clinical Auditor & Trainer 145-2034
CommunityCare HMO Inc., Tulsa, OK, United States
Job Summary
Responsible for developing, implementing, monitoring and evaluating on‑going training programs and to establish a quality assurance program for Medical Management. Assist Medical Management Supervisor with training clinical staff. Identify training opportunities through the quality audit review process and incorporating training in daily stand up, team and monthly staff meetings. Perform quality review on all operational data entry on clinical personnel and select data criteria for Medical management as it relates to regulatory requirements.
Key Responsibilities
Establish training needs for data entry errors identified during the quality review audit process.
Oversee, train and mentor new employees during training program.
Monitors and audits mechanisms and controls to ensure appropriate data entry of authorizations, accurate and timely turn around, and accurate authorization production in accordance with established departmental policy and procedures.
Plans, organizes, develops and implements a comprehensive training program to provide staff with current techniques and information relative to their assignments and updates as appropriate.
Responsible for department monitoring activities and uploading activities in Service Now.
Evaluate documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines and assess clinical staff regarding appropriate decision making.
Perform other job-related duties.
Qualifications
Ability to assess situation, consider alternatives and choose the appropriate course of action.
Ability to reason logically and to use good judgment when interpreting materials or situations.
Knowledge of managed care and associated group benefit plans.
Proficient in Microsoft applications.
Successful completion of Health Care Sanctions background check.
Ability to organize time effectively and set priorities.
Possess strong oral and written communication skills.
Education/Experience
Certified Internal Auditor (CIA) or Certified Healthcare Compliance (CHC) preferred; or ability to obtain within 24 months of employment.
Graduation from accredited School of Nursing.
Current, active, unrestrictive license to practice as Registered Nurse (RN) in the State of Oklahoma.
At least three years of clinical nursing experience in an acute care setting.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin.
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Responsible for developing, implementing, monitoring and evaluating on‑going training programs and to establish a quality assurance program for Medical Management. Assist Medical Management Supervisor with training clinical staff. Identify training opportunities through the quality audit review process and incorporating training in daily stand up, team and monthly staff meetings. Perform quality review on all operational data entry on clinical personnel and select data criteria for Medical management as it relates to regulatory requirements.
Key Responsibilities
Establish training needs for data entry errors identified during the quality review audit process.
Oversee, train and mentor new employees during training program.
Monitors and audits mechanisms and controls to ensure appropriate data entry of authorizations, accurate and timely turn around, and accurate authorization production in accordance with established departmental policy and procedures.
Plans, organizes, develops and implements a comprehensive training program to provide staff with current techniques and information relative to their assignments and updates as appropriate.
Responsible for department monitoring activities and uploading activities in Service Now.
Evaluate documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines and assess clinical staff regarding appropriate decision making.
Perform other job-related duties.
Qualifications
Ability to assess situation, consider alternatives and choose the appropriate course of action.
Ability to reason logically and to use good judgment when interpreting materials or situations.
Knowledge of managed care and associated group benefit plans.
Proficient in Microsoft applications.
Successful completion of Health Care Sanctions background check.
Ability to organize time effectively and set priorities.
Possess strong oral and written communication skills.
Education/Experience
Certified Internal Auditor (CIA) or Certified Healthcare Compliance (CHC) preferred; or ability to obtain within 24 months of employment.
Graduation from accredited School of Nursing.
Current, active, unrestrictive license to practice as Registered Nurse (RN) in the State of Oklahoma.
At least three years of clinical nursing experience in an acute care setting.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin.
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