UM Operations Clinical Auditor & Educator
Devoted Health
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Avantages offerts par ce poste
Résumé du poste
Devoted Health is seeking an UM Operations Clinical Guide to support quality, accuracy, compliance, and continuous improvement in Utilization Management. This RN role leads clinical audit activities, identifies trends, and partners with UM leadership to align processes with CMS requirements and clinical criteria.
You will act as a clinical education resource for onboarding, ongoing staff education, and targeted re-education based on findings, collaborating with Clinical leadership, Medical
Qualifications
- Active, unrestricted RN license or LVN/LPN.
- Clinical nursing experience in Utilization Management, Clinical Review, or related field.
- Experience reviewing clinical documentation and applying criteria.
- Knowledge of Medicare Advantage and CMS requirements.
- Experience conducting audits or quality reviews with medical necessity focus.
- 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 root causes.
- Develop actionable recommendations for UM leadership.
- Support staff education, onboarding, and targeted re-education.
- Partner with leaders to implement corrective actions and monitor outcomes.
- Support development of clinical audit tools and readiness activities.
Connaissances
Description du poste
Devoted Health is seeking an UM Operations Clinical Guide to support quality, accuracy, compliance, and continuous improvement in Utilization Management. This RN role leads clinical audit activities, identifies trends, and partners with UM leadership to align processes with CMS requirements and clinical criteria.
You will act as a clinical education resource for onboarding, ongoing staff education, and targeted re-education based on findings, collaborating with Clinical leadership, Medical
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