The Medical Management Auditor audits the work of staff to improve their adherence to clinical guidelines in the Utilization Review process, (Experience with Milliman and Interqual Guidelines as well as Facets is highly recommended). The Medical Management Auditor must be able to identify learning objectives, select and deliver instructional methodologies, manage internal review process to document internal inter-rater reliability and provide independent quality assurance within the department. This position will provide quarterly quality reviews of Utilization Management staff determinations and regulatory compliance and correct application of Milliman guidelines.
- AA/AS - Associates Degree or equivalent required.
- BA/BS - Bachelors Degree or equivalent preferred.
- Valid NYS RN License preferred.
- Working knowledge of Milliman and Interqual guidelines required.
- Experience in Utilization Review required.
- Experience with Facets preferred.
- Background in Case Management, Disease Management, Performance Management and Data Analysis strongly preferred.