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Utilization Management Auditor

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
Job Description
A bit about this role:
As a Clinical Auditor, you'll have the opportunity to make a difference in the lives of our members. You'll be responsible for performing regulatory, accreditation and operational audits to document compliance with standards, operational and performance improvement objectives as outlined by Management. Our Clinical Auditor is committed to integrity and excellence and facilitating onboarding and training activities to maintain compliance and improve outcomes. Our ideal Clinical Auditor is caring, compassionate and solutions-oriented, and is enthusiastic about providing an outstanding experience for Devoted Health’s members.

Responsibilities will include:
  • Develops audit tools and conducts audits as assigned to assist in management’s documentation of compliance with regulatory, accreditation and operational process improvement standards.
  • Examines and compares records and processes with required standards for accuracy and completeness in meeting currently established regulatory, accreditation and/or operational process improvement project standards. Assists in the review of new regulatory and accreditation standards on an annual or as needed basis.
  • Prepare summary of audit findings with appropriate notification to management of issues in a concise and well-documented format, with a gap analysis as appropriate and proposed action plans for improvement.
  • Conducts follow-up reviews to assess and verify effectiveness of any implemented action plans.
  • Communicates significant audit findings to management in a timely manner following the completion of audit tasks. Prepares and submits documentation of required follow-up reviews on previous audit results in a timely manner.
  • Develops and conducts effective Utilization Management orientation and training programs on operational systems and creates business practices to ensure consistent performance within plan, regulatory and accreditation standards.
  • Collaborates with management and Utilization Management staff to identify and assess learning needs impacting operational effectiveness.
  • Creates and conducts effective training programs on operational best practices & clinical training to improve staff morale, member care coordination and operational efficiency.
  • Assists with the timely development and revision of training materials, manuals, and evaluation materials. Maintains detailed records of training programs and participants and generates accurate statistical reports.
  • Develops and coordinates the presentation of continuing education activities specific to managed care principles. Prepares materials as needed to specific cases for learning opportunities in managed care principles on real-time cases.
  • Maintains technical proficiency and remains current with the latest developments, advancements and trends in utilization management compliance.

Attributes to success:
  • A desire to make a change in the healthcare experience: you love to serve and make a difference
  • Proven success in building relationships
  • The ability to adjust your tone and approach to different people
  • The ability to articulate and break down complex information. Adaptability and comfort in a dynamic, startup environment
  • Transparency in your work - what’s going well and what’s not

Desired skills and experience:
  • Ability to work in a startup, fast paced environment
  • An unrestricted RN or LVN/LPN license, or Bachelor’s degree (preferred)
  • A minimum of 4 years within Medical Management, utilization management at a Health Plan
  • The ability to comfortably multi- task and pivot priorities as needed: you’ll be listening, talking and typing all at the same time
  • Team player mentality with a can-do attitude
  • Understanding of CMS guidelines, MA requirements, and SNP (Special Needs Plans) Care Coordination Standards
  • Comply with industry specifications, standards, regulations, and laws.
  • Review operational practices
  • Documenting compliance-related processes and maintaining records.
  • Monitoring compliance and facilitating interventions to manage risks.
  • Keeping abreast of regulatory changes and developments in the regulatory environment.
Salary Range: $64,000 - $66,900
Our Total Rewards package includes:
  • Employer sponsored health, dental and vision plan with low or no premium
  • Generous paid time off
  • $100 monthly mobile or internet stipend
  • Stock options for all employees
  • Bonus or commission eligibility for all roles
  • Parental leave program
  • 401K program
  • And more....
  • Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
The salary and/or hourly range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, years of relevant experience, education, credentials, budget and internal equity).
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
Devoted Health Glassdoor Company Review
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CEO of Devoted Health
Devoted Health CEO photo
Ed Park
Approve of CEO

We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. “What’ll this be like for our members?” That’...

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DATE POSTED
June 9, 2023

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