Medical Management Auditor

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Must reside in New Jersey

• Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem
• Develop 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 related 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, develop and publish corrective actions/educational material related to audit errors
• Coordinate auditing outcomes and system maintenance with the Sr. Clinical Systems Specialist to resolve or enhance clinical systems
• Ability to travel

Must reside in NJ

Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years of related experience.

License/Certification: Current state nursing license.

Pay Range: $52,900.00 - $95,200.00 per year

Centene offers a comprehensive benefits package including: competitive pay, 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-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Job Type: Full-time

Pay: $52,900.00 - $95,200.00 per year

Benefits:

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

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• auditor: 3 years (Preferred)

License/Certification:

• New Jersey RN license (Preferred)

Work Location: Remote