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About the role
Key responsibilities & impact- Assess job-specific needs and develop technical training plans with clear business objectives
- Select training/instructional methods and procedures appropriate for the situation
- Deliver specific training sessions, including using suitable delivery methods such as classroom, online, and webinar
- Identify the development needs of others and coach, mentor, or otherwise assist others with improving their knowledge skills
- Provide support to the CCV audit team members; assist with orientation of new members as needed
- Promote audit accuracy measures by training/educating and mentoring the auditor and providing documented and validated findings
- Conduct or arrange for ongoing technical training and personal development classes for staff members
- Integrate healthcare auditing principles and use objectivity in the performance of medical audit activities and reviews
- Provide feedback on reviews to the Quality Assurance Manager as indicated
Requirements
What you’ll need- Associate or Bachelor's degree in nursing
- RN License (active/unrestricted in state of residence)
- Case Management Certification (preferred, but not required)
- 5 to 7+ years of working with InterQual/MCG (Inpatient vs Observation)
- Background in Utilization Management and/or Case Management
- Critical Care background: ICU, Emergency Room, Cath Lab, Med Surg
- 5 to 7+ years of working with a broad knowledge of medical claims, billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology
- Requires expert level knowledge of Interqual and/or MCG criteria
- Strong presentation skills
- Independent thinker, logical, strategic, with a high focus and attention to detail
- Effective communication and presentation style (written and verbal) with proven ability to positively influence behavior and outcomes
- Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects
- Competent administrative and organizational skills, ability to multitask, set priorities, and meet deadlines
- High level of proficiency with all audit technology i.e., R3, CAT, etc.
- Proficiency in Word, Access, Excel, PowerPoint and other applications
- Excellent written and verbal communication skills
Benefits
Comp & perks- Health insurance
- Dental insurance
- Vision insurance
- Disability insurance
- Life insurance
- 401(k) savings plans
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
InterQualMCGUtilization ManagementCase Managementmedical claimsbilling systemspayer reimbursement policiescoding terminologycurriculum designtraining measurement
Soft Skills
presentation skillsindependent thinkerlogical thinkingstrategic thinkingattention to detaileffective communicationpositive influenceadministrative skillsorganizational skillsmultitasking
Certifications
RN LicenseCase Management Certification
