Job Summary
A healthcare company is filling a position for a Remote Clinical Care Plan Auditor in Albuquerque.
Individual must be able to fulfill the following responsibilities:
- Review planned, in process, or completed health care services
- Propose alternatives when the requested services do not meet medical necessity criteria
- Provide information to enrollees, providers, and internal staff regarding benefits
Position Requirements Include:
- RN or clinical credentials in a behavioral health field, or must hold Masters or Doctoral Degree
- Good organization, time management and verbal and written communication skills
- Utilization management procedures, Medicaid benefits, community resources and providers
- knowledge and experience in diverse patient care settings including inpatient care
- Ability to function independently and as a team member
- Knowledge of ICD and DSM IV coding or most current edition
