Licensed RN Utilization Management Auditor

Job Summary

A company is looking for a Utilization Management Auditor.

Key Responsibilities

• Audit all stages of the Utilization Management process for compliance and effectiveness
• Evaluate cross-departmental workflows to identify systemic issues and recommend improvements
• Compile detailed audit reports and provide actionable recommendations for process enhancements

Required Qualifications

• Licensed RN is required
• Minimum of 3 years of outpatient/inpatient clinical experience
• 3-5 years of experience in healthcare operations, Utilization Management, or auditing roles
• In-depth knowledge of UM processes and healthcare regulations
• Experience in developing reporting systems related to audit activities