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.

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

Piedmont Healthcare Corporate