Telecommute Clinical Care Plan Auditor in Farmington

Job ID: Available for Members

Location: New Mexico

Compensation: To Be Discussed

Posted: Wednesday, February 28, 2018

Job Category: Case Management, Healthcare, Human Services

Telecommute Level: 100% Telecommute

Travel Requirements: No Travel

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Some College

Job Summary

A healthcare company has an open position for a Telecommute Clinical Care Plan Auditor in Farmington.

Candidates will be responsible for the following:

  • Reviewing planned, in process, or completed health care services to ensure medical necessity and effectiveness
  • Developing and managing new enrollee transitions and those involving a change in provider relationships
  • Interacting with Medical Directors and Physician Advisors to provide case information and discuss clinical and authorization questions and concerns

Required Skills:

  • Associates: Nursing (Required)
  • 2 or more years experience post degree in a clinical, psychiatric and/or substance abuse health care setting
  • Minimum of 2 years of experience conducting utilization management according to medical necessity criteria
  • RN or clinical credentials in a behavioral health field
  • Good organization, time management and verbal and written communication skills
  • Knowledge of ICD and DSM IV coding or most current edition