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UM Delegation Auditor - LVN-Utilization Management

Company: Kelsey-Seybold
Location: Pearland
Posted on: January 16, 2022

Job Description:

Overview:Kelsey-Seybold Clinic, a Houston tradition in patient-centered care, is a multispecialty clinic with over 25 locations and comprises more than 500 physicians providing primary and specialty care in a collaborative manner.
With 55 different clinical and non-clinical specialties, you can design a career path at Kelsey-Seybold Clinic that allows you to grow your future in a completely new direction.
Kelsey-Seybold Clinic is changing the way health cares.Responsibilities:The Delegation Auditor is responsible for auditing utilization management metrics and utilization review agent criteria to ensure we maintain our delegated standing with insurance companies and comply with all TDI and CMS requirements for a Texas licensed URA. This individual will compile data and track trend data over time to determine if performance standards are being met. The Delegation Auditor is responsible for performing internal audits to determine if the department is complying with the delegation criteria set forth by the applicable health plan in the delegation contracts. The auditor will conduct continuous analysis of compliance findings and progress on correcting internal deficiencies. Supports the Manager and Supervisor with the development and implementation of corrective action plans.Qualifications:UM Delegation Auditor - LVNLocation: Pearland Administrative OfficeDepartment: Managed Care ServicesJob Type: Full Time
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS(A = basics; B = preferred)
Education
A.
Bachelor's Degree in a related field or 4 years equivalent work experience.
B.
Project Management experience
Experience
A.
3+ years' experience in a Managed Care environment (MSO, ACO, Medical Group, health plan, IPA) as an internal auditor for delegated services, healthcare organization utilization management role,
OR
3+ years' experience in Health Plan Operations (claims, delegation oversight, appeals and grievances, network development, or Utilization Review)
B.
Project Management experience
Utilization Review experience at a health plan or medical group
Healthcare claims payment experience or healthcare billing office Experience
Licenses
A.
Current and valid Texas LVN license
B.
Special Skills
A.
Proficient in Microsoft Excel and Word.
Must meet a minimum standard of typing "35-40 WPM" on a typing test.
Must demonstrate the ability to clearly communicate both verbally and in writing
B.
Other A, Knowledge of state and federal Utilization review agent requirements and regulatory compliance requirements (CMS and TDI).
Ability to effectively present information and respond to questions from peers and management.
Ability to work in a fast-paced environment with changing prioritiesB.
WORKING ENVIRONMENTOffice

Keywords: Kelsey-Seybold, Pearland , UM Delegation Auditor - LVN-Utilization Management, Accounting, Auditing , Pearland, Texas

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