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Utilization Review / Comp Auditor Monitor (AL)
East Central Regional Hospital located in Augusta Georgia is seeking qualified candidates for the position of Utilization Review Manager / Comp Auditor / Monitor (AL).
Plans, organizes or coordinates the activities of an assigned program. Reviews, monitors and ensures compliance with assigned program areas policies and procedures. May supervise support staff.
Job Responsibilities & Performance Standards:
· Performs job responsibilities with minimal supervision
· Serves as job expert or organization resource in assigned areas
· May supervise and/or direct the work of others
· Conducts on-site reviews, audits or surveys of clinical and treatment facilities, regulated entity operations and program management
· Conducts utilization reviews, peer reviews, evaluation activities and all other reviews on a scheduled basis
· Coordinates investigations involving noncompliance in facilities, community programs, regulated entity operations and other related programs
· Coordinates the data management and quality assurance functions
· Determines compliance with applicable state and/or federal rules and regulations
· Develops, implements and evaluates the surveillance of utilization review process to ensure quality services
· Monitors, tracks, and maintain records on compliance
· Plans and evaluates outcome studies and/or compliance findings
· Plans, develops, schedules and implements surveys and complaint investigations for licensure or certification of regulated facilities
· Plans, organizes, and directs the certification reviews, reviews new rules and service site applications
· Recommends programmatic and/or operational changes based on review, audit or survey results
· Researches and analyzes state codes, federal regulations and industry manuals regarding forms, policies and procedures
· Reviews applications for accuracy and compliance with guidelines, regulations and laws
· Performs investigations and/or audits according to established rules, regulations and other statutes
Sample Technical Competencies:
· Knowledge of the audit process.
· Knowledge of program area.
· Ability to review files for compliance history.
· Ability to interpret statistical data.
· Ability to apply review and evaluation methods
· Ability to make compliance determinations.
Associate degree in a related field and five years experience with at least two years in a position directly related to the area of assignment Or Bachelor's degree in a related field and four years of related experience Or Master's degree in a related field and two years of related experience Or Two years experience at the lower level or a position equivalent (RCP061) Note: Some positions may require a certification or licensure Note: Some positions may require a valid driver's license.
Two years of experience in Utilization Management and Discharge planning. Knowledge of governmental regulation for Medicare, Medicaid, Champus, Prospective Payment Systems, and Third Part Payer.
In addition to a competitive salary (), we offer a generous benefits package that includes a flexible schedule, training opportunities, employee retirement plan, deferred compensation, 12 paid holidays, vacation and sick leave, dental, vision, long term care, and life insurance.
This position is a pay grade 15 on the statewide salary plan.
This position is located at East Central Georgia Regional Hospital in Augusta, Georgia.
While Augusta is known worldwide for the Masters® and the coveted green jacket, you'll find that Georgia's second-oldest and second-largest city - also known as the "Garden City" of the South - is full of history, atmosphere, Southern charm, and activities to engage everyone's interest.
Discover the historic charm of the classic South with Augusta's tree-lined streets and majestic antebellum mansions. Enjoy dozens of shops and restaurants, cultural attractions and entertainment. Meander along the banks of the Savannah River as you stroll Riverwalk Augusta. Canoe the river or the adjacent Augusta Canal.
Whatever your interest, you'll find something to satisfy it in Augusta.
Please email your cover letter and resume in Microsoft Word format to: firstname.lastname@example.org
To ensure proper routing/handling of your credentials, copy/paste or type the following title in the subject line of your email: Utilization Review / Comp Auditor Monitor (AL) If you are currently employed by DBHDD, please include "Internal Employee" in the subject line as well.
You may be subject to a Drug Screen. You may be required to submit fingerprints to check for the existence of Criminal History Record Information through the Georgia Bureau of Investigation and the Federal Bureau of Investigation. You do have the right to challenge the contents of any Criminal History that is located, should you choose to do so.
The Georgia Department of Behavioral Health and Developmental Disabilities provides services to ensure the health and welfare of Georgians. As an employee of DBHDD, in the event of an identified emergency you may be required, as a term and condition of employment, to assist in meeting the emergency responsibilities of the department.