Utilization Review (UR) Audit Personnel
Position Title:
Utilization Review (UR) Audit PersonnelLocation:
Baltimore, MD and RemoteAbout Us:
The Columbus Organization is a group of caring professionals whose mission is to assist children and adults with physical and intellectual disabilities achieve independence through a life that is meaningful to them.
With a person-centered planning and thinking approach, it is our vision to be recognized as an organization that transforms individuals' lives and provides families the peace of mind in knowing their loved one has a voice and a valued role in their community.
UR Audit Personnel Position
Summary:
The UR Audit Personnel position is responsible for conducting utilization reviews for people with intellectual and developmental disabilities who are receiving services funded by the Maryland Developmental Disabilities Administration.
This includes verifying the quality and quantity of authorized units of services; reviewing provider documentation to justify that a service was rendered according to an individual's person-centered plan; and interviewing the individual, their family, and provider to determine the services were rendered.
Benefits Offered:
Cigna Medical/Dental/PrescriptionShort- and Long-Term DisabilityVision CareFlexible Spending AccountsLife Insurance with Buy-Up Option401(k) Retirement Savings PlanWorkers' Compensation InsuranceHealth Savings AccountHealth Advocacy ProgramEmployee Assistance Program (EAP)Accident/Hospital/Cancer Plans
Responsibilities:
Monitoring of Basic Waiver Assurances, including Level of Care Reviews, Service Plan Reviews, Health and Welfare Reviews, Qualified Provider Reviews, and Financial Accountability Reviews.
Conduct utilization reviews to verify the provision and quantity and quality of services by auditing provider-related documents (eg, staff notes, logs, staffing plan, timesheets, payroll records, receipts, other required documentation).
Conduct National Core Indicator surveys, including interviews with consumers, family members, providers, and other individuals as needed.
Aid in achieving Council on Quality and Leadership (CQL) accreditation.
Prepare audit reports based on review of documentation and overall findings.
Report any significant health and safety issues; or actual or suspected abuse, mistreatment, or neglect; or evidence of fraud or other financial mis-dealings immediately to appropriate parties.
Qualifications/Requirements:
Bachelor's or master's degree in health and human services or related field and a minimum of three years of experience in providing public sector Utilization Review of Medicaid Services.
Ability to travel throughout the state as needed.
Knowledge of planning principles and report preparation.
Skill in interpreting policies and procedures.
Skill in analyzing situations, evaluating information, and recommending course of action.
Skill in maintaining effective working relationships with fellow employees and outside agencies.
Ability to evaluate issues and explain rules and regulations.
Ability to write reports and correspondence.
Ability to define problems and collect data, establish facts, and draw valid conclusions.
#LP.
Estimated Salary: $20 to $28 per hour based on qualifications.
Utilization Review (UR) Audit PersonnelLocation:
Baltimore, MD and RemoteAbout Us:
The Columbus Organization is a group of caring professionals whose mission is to assist children and adults with physical and intellectual disabilities achieve independence through a life that is meaningful to them.
With a person-centered planning and thinking approach, it is our vision to be recognized as an organization that transforms individuals' lives and provides families the peace of mind in knowing their loved one has a voice and a valued role in their community.
UR Audit Personnel Position
Summary:
The UR Audit Personnel position is responsible for conducting utilization reviews for people with intellectual and developmental disabilities who are receiving services funded by the Maryland Developmental Disabilities Administration.
This includes verifying the quality and quantity of authorized units of services; reviewing provider documentation to justify that a service was rendered according to an individual's person-centered plan; and interviewing the individual, their family, and provider to determine the services were rendered.
Benefits Offered:
Cigna Medical/Dental/PrescriptionShort- and Long-Term DisabilityVision CareFlexible Spending AccountsLife Insurance with Buy-Up Option401(k) Retirement Savings PlanWorkers' Compensation InsuranceHealth Savings AccountHealth Advocacy ProgramEmployee Assistance Program (EAP)Accident/Hospital/Cancer Plans
Responsibilities:
Monitoring of Basic Waiver Assurances, including Level of Care Reviews, Service Plan Reviews, Health and Welfare Reviews, Qualified Provider Reviews, and Financial Accountability Reviews.
Conduct utilization reviews to verify the provision and quantity and quality of services by auditing provider-related documents (eg, staff notes, logs, staffing plan, timesheets, payroll records, receipts, other required documentation).
Conduct National Core Indicator surveys, including interviews with consumers, family members, providers, and other individuals as needed.
Aid in achieving Council on Quality and Leadership (CQL) accreditation.
Prepare audit reports based on review of documentation and overall findings.
Report any significant health and safety issues; or actual or suspected abuse, mistreatment, or neglect; or evidence of fraud or other financial mis-dealings immediately to appropriate parties.
Qualifications/Requirements:
Bachelor's or master's degree in health and human services or related field and a minimum of three years of experience in providing public sector Utilization Review of Medicaid Services.
Ability to travel throughout the state as needed.
Knowledge of planning principles and report preparation.
Skill in interpreting policies and procedures.
Skill in analyzing situations, evaluating information, and recommending course of action.
Skill in maintaining effective working relationships with fellow employees and outside agencies.
Ability to evaluate issues and explain rules and regulations.
Ability to write reports and correspondence.
Ability to define problems and collect data, establish facts, and draw valid conclusions.
#LP.
Estimated Salary: $20 to $28 per hour based on qualifications.
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