Utilization Management Clinical Audit Administrator - JOHNS HOPKINS HEALTH SYSTEM - Baltimore, MD

Utilization Management Clinical Audit Administrator - JOHNS HOPKINS HEALTH SYSTEM - Baltimore, MD -

Johns Hopkins Well being System employs greater than 20,000 individuals yearly. When becoming a member of the Johns Hopkins Well being System, you turned a part of a various group devoted to its sufferers, their households, and the group we serve, in addition to to our staff. Profession alternatives can be found in educational and group hospital settings, house care providers, doctor practices, worldwide affiliate places and within the well being insurance business. Nice careers regularly advance right here.

Place Abstract : The Clinical Audit Administrator is chargeable for the event and management packages associated to regulatory reimbursement, together with the oversight of the Restoration Audit Contractor implementation and the Medicaid Integrity Challenge. The Clinical Audit Administrator studies on to the Senior Director of Utilization Management/ Clinical Useful resource Management and helps her in implementing the group’s regulatory reimbursement management plan in accordance with the mission and strategic objectives of the group, federal and state regulation and laws, payor necessities and accreditation requirements. The Clinical Audit Administrator additionally offers different regulatory entities employees help in venture planning and implementation. Competencies : A.

Schooling: Requires instructional background in healthcare management, which can embrace medical or course of management. Bachelors required; Grasp’s Diploma in Nursing or Enterprise or Healthcare Administration most popular B. Information: Wonderful information base associated to reimbursement practices, monetary and knowledge evaluation, third celebration payor laws, utilization management requirements, case management methodologies, age particular and different regulatory and accreditation necessities associated to UR and price containment. Maintains present information regulatory requirements.

Expertise with Microsoft Workplace packages and/or with phrase processing, databases and spreadsheets. C. Expertise: Superior interpersonal expertise to work together with all ranges of inner and exterior clients. Demonstrated potential to affect and negotiate particular person and group determination making.

Means to perform successfully in a fluid, dynamic and quickly altering surroundings. Demonstrated capability to research, synthesize, and summarize info to make judgments. D. Required Licensure, Certification, And so on.: E.

Work Expertise Requires seven to 10 years associated expertise. Should have expertise with automated databases for dealing with utilization management info. Managed care contracting and/or payer relations expertise required. Day Shift, Full Time (40 hours) (eight:00AM -5:00PM ) Exempt, Pay Grade: ML Work Working Circumstances: Works in regular workplace surroundings the place there’s little discomfort to because of the extremes of warmth, mud, noise, temperature and the like Johns Hopkins is a Smoke-Free Campus.

Johns Hopkins Well being System and its associates are Equal Alternative/Affirmative Motion employers. All certified candidates will obtain consideration for employment with out regard to race, shade, faith, sexual orientation, gender id, intercourse, age, nationwide origin, incapacity, protected veteran standing, and or some other standing protected by federal, state, or native regulation.

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