HMS Career Opportunities
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NJ Clinical Audit Manager
NJ - Trenton
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The Clinical Audit Manager is the main point of contact with the New Jersey Division of Medical Assistance and Health Services and is responsible for coordinating all administrative activities for the New Jersey Medicaid Reviews contract.

Job Duties:

  • Oversees and manages New Jersey Utilization Review contract
  • Prepares outcome reports that show findings from project / contract activities, highlighting opportunities for process improvement
  • Effectively communicates project findings to ensure that quality improvement activities result in measurable improvements
  • Performs quality assurance checks on final reviews and client deliverables
  • Coordinates reviews with Medical Director and physician reviewers as appropriate
  • Serves as a resource to participants in project / contract activities
  • Maintains professional competencies and knowledge for project, community relations, and customer service responsibilities as necessary for project
  • Prepares presentations and reports in concert with contract deliverables.
  • Monitors and fulfills contract requirements.
  • Meets with client regularly.
  • Manages assigned staff. Facilitates resolution of concerns and employee relations issues. Provides ongoing feedback, coaching, guidance, and direction in daily responsibilities.
  • Facilitates team processes to ensure project / contract implementation and performance

Basic Skills/ Knowledge Needed:

  • Active, unrestricted RN license in New Jersey required
  • 2 years project management experience
  • DRG coding and utilization review experience needed
  • Familiar with state and federal laws and practices as it relates to: Inpatient DRG reimbursement, Medical records requests, utilization review and overpayment recovery
  • Customer service, provider relations or client management experience required
  • Report generation experience (MS Office Suite)
  • Excellent interpersonal and communication skills (both written and oral)
  • Knowledge in and successful application of basic level of health care data analysis and clinical review.
  • Bachelor's degree (BA/BS) from a four-year college or university in Nursing, Health Care Administration preferred
  • Demonstrated leadership skills and successful experience working in an interdisciplinary team environment.
  • Knowledge in and successful application of needs assessments skills
  • Demonstrated ability to effectively manage multiple priorities and multi-level tasks.

The Clinical Audit Manager is the main point of contact with the New Jersey Division of Medical Assistance and Health Services and is responsible for coordinating all administrative activities for the New Jersey Medicaid Reviews contract.

Job Duties:

  • Oversees and manages New Jersey Utilization Review contract
  • Prepares outcome reports that show findings from project / contract activities, highlighting opportunities for process improvement
  • Effectively communicates project findings to ensure that quality improvement activities result in measurable improvements
  • Performs quality assurance checks on final reviews and client deliverables
  • Coordinates reviews with Medical Director and physician reviewers as appropriate
  • Serves as a resource to participants in project / contract activities
  • Maintains professional competencies and knowledge for project, community relations, and customer service responsibilities as necessary for project
  • Prepares presentations and reports in concert with contract deliverables.
  • Monitors and fulfills contract requirements.
  • Meets with client regularly.
  • Manages assigned staff. Facilitates resolution of concerns and employee relations issues. Provides ongoing feedback, coaching, guidance, and direction in daily responsibilities.
  • Facilitates team processes to ensure project / contract implementation and performance

Basic Skills/ Knowledge Needed:

  • Active, unrestricted RN license in New Jersey required
  • 2 years project management experience
  • DRG coding and utilization review experience needed
  • Familiar with state and federal laws and practices as it relates to: Inpatient DRG reimbursement, Medical records requests, utilization review and overpayment recovery
  • Customer service, provider relations or client management experience required
  • Report generation experience (MS Office Suite)
  • Excellent interpersonal and communication skills (both written and oral)
  • Knowledge in and successful application of basic level of health care data analysis and clinical review.
  • Bachelor's degree (BA/BS) from a four-year college or university in Nursing, Health Care Administration preferred
  • Demonstrated leadership skills and successful experience working in an interdisciplinary team environment.
  • Knowledge in and successful application of needs assessments skills
  • Demonstrated ability to effectively manage multiple priorities and multi-level tasks.
HMS is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
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