Job Information
Centene Corporation Medical Management Auditor in Trenton, New Jersey
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 NJ
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
Performs other duties as assigned
Complies with all policies and standards
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.
For New Jersey Health Plan Only: State unrestricted license as Licensed Clinical Mental Health Counselor, Licensed Clinical Social Worker (LCSW), Registered Nurse (RN), Licensed Psychologist (Psy.D.), Licensed Marriage and Family Therapist (LMFT) may also be used.
Pay Range: $54,000.00 - $97,100.00 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.