Medical Management Auditor - Behavioral Health (Apply in minutes)
Sunshine State Health Plan Miami Full-time
You could be the one who changes everything for our 28 million members.
Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Mental
Health Counselor (LMHC), Registered Nurse (RN), or Licensed Psychologist
time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an
individuals skills, experience, education, and other job-related factors
permitted by law. Total compensation may also include additional forms of
Centene is transforming the health of our communities, one person at a time.
As a diversified, national organization, you’ll have access to competitivebenefits including a fresh perspective on workplace flexibility.
**Position Purpose:** Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry andor 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 actionseducational 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
- Performs other duties as assigned
- Complies with all policies and standards
experience. 3+ years of related experience.
**LicenseCertification:** State unrestricted license as Licensed MasterSocial Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Mental
Health Counselor (LMHC), Registered Nurse (RN), or Licensed Psychologist
(Ph.D. or Psy.D.)
This supports our Behavioral Health Team in Florida.
Pay Range: $55,100.00 - $99,000.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paidtime off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an
individuals skills, experience, education, and other job-related factors
permitted by law. Total compensation may also include additional forms of
incentives.
Centene is an equal opportunity employer that is committed to diversity, andvalues 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, veteranstatus, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered inaccordance with the LA County Ordinance and the California Fair Chance Act
Sunshine State Health PlanHialeah, 11 mi from Miami
perspective on workplace flexibility.
**Position Purpose:** Assist the Chief Medical Director to direct and
coordinate the medical management, quality improvement and credentialing
functions for the business unit. Florida residence, required.
• Provides...
Medical Management Auditor - Behavioral Health - Workplace Flexibility and Comprehensive Benefits...
Sunshine State Health PlanMiami
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...
Sunshine State Health PlanMiami
perspective on workplace flexibility.
**Position Purpose:** Assist the Chief Medical Director to direct and
coordinate the medical management, quality improvement and credentialing
functions for the business unit. Florida residence, required.
• Provides...