UM Clinical Audit Lead (RN) — Quality & Compliance

Devoted; United States; Sur place; USD 82 000 - 96 000; Plein temps

Avantages offerts par ce poste

Employer sponsored health, dental and/

Vision plan

Generous paid time off

$100 monthly mobile or internet

Stock options for all employees

Bonus eligibility for most roles

Parental leave program

401K program

Résumé du poste

Devoted Health is seeking an UM Operations Clinical Guide in the United States to oversee clinical audits, monitor CMS compliance, and drive continuous improvement within the Utilization Management team.

The role acts as a clinical education resource, supporting new-hire training and ongoing staff development while partnering with Compliance, Quality, and Medical Directors to ensure accurate, compliant UM practices.

Qualifications

• Active RN license in good standing.
• Clinical nursing experience in UM, clinical review, or audit.
• Experience reviewing clinical documentation and applying criteria.
• Knowledge of Medicare Advantage UM processes and CMS requirements.
• Strong analytical, organizational, and communication skills.

Responsabilités

• Conduct ongoing Clinical Review audits and monitoring for the assigned UM team.
• Analyze audit results to identify trends and opportunities for improvement; translate findings into actions.
• Support new-hire on-the-job training and ongoing staff education.
• Develop and implement corrective actions; validate and monitor results.
• Support the development, maintenance, and enhancement of audit tools and methodologies.
• Participate in CMS and regulatory readiness activities; maintain audit documentation.
• Collaborate with UM leadership, Medical Directors, Compliance, Quality, and other stakeholders.
• Escalate significant clinical or regulatory concerns through established channels.

Connaissances

RN license

Clinical nursing experience

CMS requirements knowledge

Clinical audits/monitoring

Analytical skills

Communication

Cross-functional collaboration

Formation

Registered Nurse (RN) license

Outils

InterQual criteria

Description du poste

Devoted Health is seeking an UM Operations Clinical Guide in the United States to oversee clinical audits, monitor CMS compliance, and drive continuous improvement within the Utilization Management team.

The role acts as a clinical education resource, supporting new-hire training and ongoing staff development while partnering with Compliance, Quality, and Medical Directors to ensure accurate, compliant UM practices.