Case Management Systems Auditor

We are recruiting for a Case Management Systems Auditor to join our Company.

Job Summary:

The Case Management Systems Auditor provides objective review of Case Management documentation to ensure consistency and adherence to case management policies, processes and documentation requirements. Provides evaluation, education and consultation to Case Management departments across the Hospital Division. Plans, organizes, directs, and coordinates internal case management documenation audits and staff education to assure case management documentation accuracy and compliance. Compiles statistical reports from audit findings, as appropriate.

Essential Functions : (Those functions that the individual who holds the position must be able to perform unaided or with the assistance of reasonable accommodation).

• Conduct off site data reviews and audits to evaluate compliance with documentation requirements, utilization requirements, and medical necessity requirements and to identify potential risk areas as well as best practices.
• Conduct on and off-site audits, records review, and observation of systems and processes to identify potential risk areas and best practices, and to provide consultation and training. Facilitate early and appropriate interventions to potential risks as well as promote best practices. As indicated or requested, conduct follow-up reviews/visits and/or ensure corrective action is implemented
• Provide expertise and serve as a resource on implementation, education and compliance with the Kindred Care Coordination Program.
• Establish tracking mechanisms of evaluation/assessment results to identify trends and respond to non-compliance.
• Develops and enhances audit tools.
• Provides audit results from each audit in an educational fashion. Serves as a resource to Kindred facilities related to concurrent review and medical necessity documenation. Provides ongoing education to case managers, and other clinical staff.
• Maintains professional skills and refines expertise through appropriate educational/developmental activities and professional affiliations
• Demonstrates effective critical thinking skills
• Other duties as assigned.

• Strong computer skills (Excel, PowerPoint and Word, various database applications; Internet; and various Kindred specific/in-house applications).
• Appropriate telephone communication skills.
• Maintains professional skills and refines expertise through appropriate educational/developmental activities and professional affiliations
• Analytical and problem solving skills.
• Strong communication skills both oral and written.
• Knowledge of medical necessity requirement, Payor regulations and standards across the continuum of care.

• Must read, write and speak fluent English.
• Must have good and regular attendance.
• Approximate percent of time required to travel: 10
• Performs other related duties as assigned.

• Associate degree in related field required. Graduation from an accredited Bachelors of Science in Nursing preferred; current, unrestricted state licensure.
• 3 years Case Management experience, UR/UM experience preferred.
• Excellent oral and written communication and interpersonal skills.

Depending on a candidate's qualifications, this position may be filled at a different level.

If you are a current Kindred/RehabCare employee Click Here .