The Delegation Auditor is responsible for auditing utilization management metrics and utilization review agent criteria to ensure we maintain our delegated standing with insurance companies and comply with all TDI and CMS requirements for a Texas licensed URA. This individual will compile data and track trend data over time to determine if performance standards are being met. The Delegation Auditor is responsible for performing internal audits to determine if the department is complying with the delegation criteria set forth by the applicable health plan in the delegation contracts. The auditor will conduct continuous analysis of compliance findings and progress on correcting internal deficiencies. Supports the Manager and Supervisor with the development and implementation of corrective action plans
Job Title: Utilization Management Delegation Auditor (LVN)
Clinic Location: Pearland Administrative Office
Department: KCA KS Health Plan Ops
Job Type: Full Time
Salary Range: $68,827 – $85,030 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Required: Bachelor’s Degree in a related field from an accredited institution or substitute degree with 4 years equivalent related work experience
Required: Minimum of 3 years’ experience in a Managed Care environment (MSO, ACO, Medical Group, health plan, IPA) as an internal auditor for delegated services, healthcare organization utilization management role
Minimum of 3 years’ experience in Health Plan Operations (claims, delegation oversight, appeals and grievances, network development, or Utilization Review)
Preferred: Project Management experience
Utilization Review experience at a health plan or medical group
Healthcare claims payment experience or healthcare billing office Experience
Required: Current and valid Texas LVN license
Required: Proficient in Microsoft Excel and Word.
Must meet a minimum standard of typing “35-40 WPM” on a typing test.
Must demonstrate the ability to clearly communicate both verbally and in writing
Required: Knowledge of state and federal Utilization review agent requirements and regulatory compliance requirements (CMS and TDI).
Ability to effectively present information and respond to questions from peers and management.
Ability to work in a fast-paced environment with changing priorities
Working Environment: Office
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance