Utilization Management Auditor
4 days ago
Tampa
Job Description Job Summary:The Utilization Management (UM) Auditor is responsible for leading audit functions within the UM department to ensure accuracy, consistency, and compliance in case reviews. This role focuses on evaluating decisions made by UM Analysts, ensuring alignment with payer medical policies and established clinical guidelines, while identifying trends, gaps, and opportunities for performance improvement. Key Responsibilities: • Conduct transactional audits to evaluate decision accuracy and quality of UM case reviews, • Ensure determinations align with payer medical policies and approved clinical criteria (InterQual / Milliman Care Guidelines), • Maintain consistency across utilization management decisions, • Review UM analyst performance beyond standard case evaluations, • Identify error trends and patterns in audit findings, • Analyze training gaps and areas of criteria misinterpretation, • Support development and improvement plans for underperforming team members, • Provide feedback and recommendations to improve quality and compliance, • Strong knowledge of Utilization Management processes and workflows, • Experience with InterQual and/or Milliman Care Guidelines, • Analytical and auditing skills with strong attention to detail, • Ability to identify trends, gaps, and performance issues, • Strong understanding of payer medical policies, • Excellent written and verbal communication skills, • Ability to work independently and lead audit initiatives, • Experience in healthcare quality assurance or compliance auditing Education: Bachelors Degree Company DescriptionCompunnel Inc., established in 1994; is a leading provider of Staffing, IT/Software, e-Learning/Training, Business Intelligence, and Cloud Solutions. A leader in contingent and permanent workforce solutions, we also provide temp-to-hire staffing, project-based/SOW staffing, and payroll services to our esteemed clientele which includes Fortune 500 companies of diverse industry segments. Ranked as one of the largest staffing firms in the US which is our primary service market; we also have a significant presence in Europe and Asia. As a national service provider in the US, we are serving our customers all major states and regions; thereby generating numerous job opportunities for prospective employees in their preferred locations of choice. We have witnessed multi-fold YOY growth, and continuously adding a large pool of talented resources to our employee base every year. Our extensive experience in hiring professionals of multiple in-demand skill sets (IT, Engineering, Healthcare, Admin-Clerical, Finance, Professional, Light Industrial, etc.) further makes Compunnel a wider and preferred platform for people to pursue their careers in the US. We welcome people from all walks of life and cultures, and we support workforce diversity by providing equal employment opportunities to people without any discrimination based on race, color, gender, religion, national/ethnic region, disability, or any other basis.Compunnel Inc., established in 1994; is a leading provider of Staffing, IT/Software, e-Learning/Training, Business Intelligence, and Cloud Solutions. A leader in contingent and permanent workforce solutions, we also provide temp-to-hire staffing, project-based/SOW staffing, and payroll services to our esteemed clientele which includes Fortune 500 companies of diverse industry segments. Ranked as one of the largest staffing firms in the US which is our primary service market; we also have a significant presence in Europe and Asia. As a national service provider in the US, we are serving our customers all major states and regions; thereby generating numerous job opportunities for prospective employees in their preferred locations of choice.\r\n\r\nWe have witnessed multi-fold YOY growth, and continuously adding a large pool of talented resources to our employee base every year. Our extensive experience in hiring professionals of multiple in-demand skill sets (IT, Engineering, Healthcare, Admin-Clerical, Finance, Professional, Light Industrial, etc.) further makes Compunnel a wider and preferred platform for people to pursue their careers in the US. We welcome people from all walks of life and cultures, and we support workforce diversity by providing equal employment opportunities to people without any discrimination based on race, color, gender, religion, national/ethnic region, disability, or any other basis.