Join GHR Healthcare: Seeking a Dynamic UM Audit RN Coordinator!

Shift: Monday – Friday (normal business hours) Tuesday - Thursday Onsite

Pay Rate: $35.00 -37.00 HR (paid weekly and eligible for health benefits)

Job Summary

The candidate MUST have Managed Care, and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA.. The candidate MUST have Managed Care, and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA..

Responsibilities include but not limited to:

· Performs audits and conducts ongoing monitoring of delegated entities to ensure compliance with federal and state laws, accreditation standards

· Reviews materials submitted, including policies, files, program documents and other materials relevant to the audit

· Conducts analysis of data related to vendor performance, and identifies opportunities for improvement

· Writes audit reports, manage corrective action plan

· Presents findings and recommendations to the Delegation Oversight Committee

· Conducts annual risk assessment that identifies and evaluates delegation risk

· Collects and prepare documents in preparation for audits.

· Actively participates in CMS program audits

· Knowledge of Part C Organization Determination guidelines and National Committee for Quality Assurance (NCQA) standards

Qualifications

Education

• LCSW, LMFT, LPC, or Active PA Licensed RN (BSN Preferred)

About Us:

With over 30 years of healthcare staffing experience, GHR Healthcare is your trusted partner in finding the perfect contract or permanent role in the healthcare industry. Our specialized teams have placed thousands of healthcare professionals nationwide. You will have a dedicated recruiter, providing access to new opportunities and guidance every step of the way. Whatever your career goals, GHR Healthcare is here to support you and find your perfect fit. Get to know us: www.ghrhealthcare.com

We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Job Types: Full-time, Contract

Pay: $34.00 - $37.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Medical specialties:

• Geriatrics

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Utilization review: 1 year (Preferred)

License/Certification:

• RN (Preferred)

Work Location: In person