Bring your experience to a role where you will:
- Supervise the Nurse Audit team and act as a resource for professional and support staff.
- Oversee and coordinate team activities to achieve business objectives and ensure medically necessary, cost-effective, quality care is delivered to members.
- Be responsible for ensuring that medical payments are appropriate and in alignment with contract provisions, proper coding, and policy compliance.
Competencies and Knowledge:
- Extensive knowledge of ICD10 coding and claim payment reimbursement.
- Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
- Ability to communicate effectively, verbally and in writing, including with members, employer, or provider groups.
- Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).
- Demonstrated experience in recognizing problems and effectively resolving complex issues.
- Familiarity with health insurance industry trends and technology.
- Demonstrated competency related to clinical utilization management and care management practices.
- Ability to apply best practices and designated standards.
Normally to be proficient in the competencies listed above:
Supervisor of Nurse Audit would have a bachelor’s degree in Nursing or related field and 3 years of leadership experience and 5 years of clinical experience or equivalent combination of education and experience.
Required Licenses, Certifications, Registration, Etc.
- Must have Registered Nurse Licensure in either WA, OR, UT, or ID and at least 3 years full-time equivalent direct clinical care.
- Applicants possessing AHIMA credentials (RHIT/RHIA/CCS) preferred.
2+ to 5 years experience
IDEAL CANDIDATE: The ideal candidate would have Clinical Supervisory experience from another health insurance plan in addition to having auditing and potentially coding experience.
Additional Information
All your information will be kept confidential according to EEO guidelines.
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