DescriptionThe Compliance (UM) Professional 2 conducts and summarizes compliance audits. The Compliance (UM) Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Compliance (UM) Professional 2 collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Ensures mandatory reporting completed. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Active non-restricted RN Florida Licensure and ability to be licenses in multiple states without restriction.
- A minimum of 2 years of Registered Nurse experience, in managed care and/or acute care, skilled, or rehabilitation clinical setting
- Ability to work independently under general instructions and within a team
- Excellent interpersonal, written, and verbal communication skills
- Strong analytical, organizational, and time management skills. Must be able to analyze data to conclude whether or not the correct determination was made, must be able to multitask, and meet goal within a specific timeframe
- Ability to utilize, navigate, and generate Microsoft Word Documents and basic reports in Excel
- At least 1 year of auditing and chart review experience in one or more of the following areas, prior authorization, care management, utilization management, clinical claims review
- MBA and/or Master's degree in Business, Engineering, Math, Health Administration, Accounting or related field
- Experience in managed care or healthcare administration desired.
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours40