Utilization Management Specialist

Education

• UG: Other Graduate, B.Sc in Nursing

Key Skills

• Spoken English
• Nursing
  
• Computer Skills
  
• Patient Chart Review
  
• Clinical Documentation
  

Job description

• Completes audits according to an established audit schedule and audit procedures
  
• Based on audit findings, provide feedback for opportunities for improvement
• Submits medical record audits within timely manner and completes follow up activities as directed
  
• Monitors and provides follow up on requested audit corrections by the organization to ensure they have been completed
• Maintains a high level of confidentiality relating to resident information, audit reviews and findings
  
• Notifies supervisor of any critical incidents identified in the medical record
  
• Participates in required training sessions and staff meetings
  
• Performs other duties as requested

Preferred candidate profile

• College nursing degree, Registered Professional Nurse with active license in India
  
• Minimum 2 years of bedside nursing experience
• 2 years or more of experience in healthcare auditing, preferred
  
• Ability to work with sensitive and/or confidential information. Knowledge of confidentiality 5aws and healthcare regulatory and compliance (HIPAA) regulations
• Proficient in Microsoft Office especially Word and Excel
  
• Experience with use of with electronic medical records, preferred
  
• Ability to learn and adapt quickly, strong attention to detail and prioritize projects appropriately
  
• Ability to work effectively as a team member and meet time deadlines
• Bi-lingual English (spoken and written)