Responsibilities
This position is responsible to provide Utilization Management expertise and program development/operational support to the UM team and audit for compliance with CMS guidelines. This position is critical to staff growth and development and maintaining staff at the cutting edge of utilization review practice while complying with regulatory guidelines. The Utilization Management Educator & Quality Auditor will assess, plan, implement and improve methods and processes of education and training for meeting employee learning needs for enhancing job performance, competency, and overall program performance. The Utilization Management Educator & Quality Auditor will also act as the internal UM performance improvement coach and provide process evaluation and recommendations for process improvement.Qualifications
Education- Bachelor’s Degree in Nursing or a related field Required Work Experience
3 years of experience in a broad range of clinical settings, utilization management, or case management. InterQual and MCG experience Required
Epic experience Preferred
InterQual Certified Instructor (IQCI) Preferred
Licenses and Certifications- RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required Business Unit : Company Name
Piedmont Healthcare Corporate
Piedmont Healthcare is a healthcare system that operates inpatient and outpatient service lines across multiple facilities within the Piedmont System. The organization manages comprehensive healthcare services with a focus on accurate medical coding, revenue cycle operations, and quality patient documentation. Piedmont Healthcare emphasizes employee wellness, professional development, and recognition, with leadership invested in staff success and career advancement.
