Utilization Review Nurse-Trainer/Auditor Details

Utilization Review Nurse-Trainer/Auditor

Conduent - Jefferson City, MO

Employment Type : Full-Time

About Conduent: Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.Job Description: The Utilization Nurse- Auditor/Trainer is responsible for education, training, and auditing of the health care staff. The Auditor/Trainer has a working knowledge of precertification of services or procedures, concurrent review, and retrospective review with a solid understanding of national evidence-based medical guidelines and utilization review policies and procedures. The Health Care Auditor/Trainer interacts regularly with health care staff to ensure consistency and accuracy of utilization review policy and procedures. The Auditor/Trainer leads quality improvement activities and ensures quality management program goals are established and met. The Auditor/Trainer works with ancillary departments to ensure system performance and improvements are made according to utilization review policy.
ESSENTIAL DUTIES & RESPONSIBILITIES Promotes a safety awareness and commitment at all times.

• Interacts professionally and efficiently with other employees and clients to achieve the Company’s

Vision and Mission Statement.

• Establishes and maintains effective working relationships with staff.
• Maintains confidentiality of information received from providers and staff.
• Uses policy and established evidenced based guidelines/criteria to certify services, based on information obtained from attending physician and/or other providers. Refers cases that do not meet evidenced based guidelines/criteria to Physician Review for determination if they do not meet established medical criteria.
• Organizes and leads new employee training.
• Regularly interacts with staff and the client
• Acts as primary contact with staff & client for supervisor coverage.
• Leads quality improvement strategies
• Completes system end-user testing from start to finish .
• Assists in the implementation and adherence to policies, procedures, and new programs
• Participates in professional nursing organizations and/or continuing education opportunities.
• Maintains knowledge of cultural differences
• Maintains current knowledge of related healthcare Federal and State regulations.
• Performs all activities within the scope of licensure and acts within the scope of Federal and State laws, licensure/certification.
• Collaborates with other departments
• Ability to read and interpret Plan policy and other related resources
• Travels to client (employer) sites for meetings as needed. Requires valid driver’s license.

EXPERIENCE/ABILITY REQUIRED:

• Minimum of 5 years nursing experience in an acute care or relevant setting.
• Experience with utilization review and quality improvement initiatives.

· Proficiency in Microsoft Windows and Works (others as identified by supervisor), and the Internet· Effective communication skills

• Attention to detail
• Ability to work independently, with minimal supervision.

EDUCATION/LICENSURE/CERTIFICATION:

• Registered Nurse licensure in Missouri and multistate licensure when applicable.
• Certification in appropriate field of expertise, preferred.

Closing: Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent’s ADAAA Accommodation Policy.