Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Dothan, Alabama

VIVA HEALTH, ranked one of the Best Places to Work by Modern Healthcare, has an opportunity for Supervisor, Community Health Workers, in Dothan AL! The Supervisor, Community Health Workers (CHW) leads an assigned team by directing workflow, ensuring quality assurance, providing training and monitoring the activities of the Alabama Coordinated Health Network (ACHN) department. This individual will carry out both routine and specialized office tasks which may include preparing reports and presentations, marketing and database maintenance. This role works closely with management to ensure compliance with regulatory standards, policies and guidelines.

This position requires a strong understanding of department policies and procedures to effectively coordinate workflow and support compliance across all areas of the department's operations.

REQUIRED

Bachelor's degree or equivalent experience Three years of clerical/adminstrative support experience in working with Alabama Medicaid or Medicare recipients Working knowledge of Microsoft Word and Excel Working knowledge of the policies and procedures of the department Working knowledge of managed care, provider network, health care delivery systems, CMS and Employee Retirement Income Security Act (ERISA) guidelines Excellent oral and written communication skills Excellent organizational skills and ability to use time management, multi-tasking and critical thinking skills to navigate a heavy workflow within an active environment Ability to work well with internal and external customers to resolve any issues that arise Ability to navigate a computer and use applicable software as required Ability to discern and interpret medical terminology Ability to make independent decisions within the parameters of job functions Ability to interact and maintain professionalism with management, physicians, outside providers and vendors Ability to work non-standard hours to ensure complete follow-up of a project or presentation efforts

PREFERRED

Working knowledge of CMS Organization Determinations, Appeals and Grievances (ODAG) and Part C reporting requirements Utilization review or precertification experience Experience providing quality assurance and audit of workflows/processes in an administrative support setting Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.