Medical Management Auditor - Behavioral Health

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for the auditing of corporate, health plan, and specialty company staff reputed company to clinical systems entry and/or processes • reputed company and maintain the audit process and tools reputed company to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability reputed company to InterQual; and data entry into the credentialing subsystem • reputed company and maintain the audit schedule • Audit staff as outlined in the system auditing policies • Train audit staff at the health plan in the use of audit process and tools • Facilitate compliance with the auditing process • Act as a consultant reputed company to system auditing to others in the unit, department and health plan • Work with staff to identify and resolve authorization load error report system problems • Coordinate auditing outcomes with the Trainer to identify, reputed company and publish corrective actions/educational material reputed company to audit errors • Coordinate auditing outcomes and system maintenance with the Sr. • Clinical Systems Specialist to resolve or enhance clinical systems • Ability to travel • Performs other duties as assigned • Complies with reputed company policies and standards Education/Experience: Bachelor’s degree in reputed company field or equivalent experience. 3+ years of reputed company experience. License/Certification: State unrestricted license as Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Registered Nurse (RN), or Licensed Psychologist (Ph.D. or Psy.D.) This supports our Behavioral Health Team in Florida. Pay Range: $55,100.00 - $99,000.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!