LTSS Auditor, RN - Remote in Michigan

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. We are currently seeking reputed company professionals with LTSS or HCBS background and solid interpersonal skills to join reputed company. The LTSS Auditor will be responsible for ensuring LTSS members receive appropriate care in the least restrictive setting possible. If you are located in Michigan, you will have the flexibility to work remotely* as you take on some tough challenges. This is a work from home / telecommute position. Candidates must be able to work Monday - Friday from 8:00 am - 5:00 pm EST. Primary Responsibilities:

• Reviewing and evaluating assessments, care plans, and other documentation to determine if the individual meets the specific LTSS or HCBS waiver eligibility criteria
• Assessing the members’ needs to ensure that the proposed services and support are medically necessary and appropriately reputed company with their person-centered plan of care
• Ensuring compliance with relevant federal and state regulations, clinical guidelines, and quality standards for LTSS/HCBS programs
• Collaborating with other reputed company, such as case managers, physicians, and nurses, to gather necessary information and clarify documentation
• Making recommendations for approval or denial of LTSS and HCBS waiver services based on their clinical review
• Participating in quality assurance activities and identifying areas for improvement in service delivery and documentation practices
• Maintaining up-to-date knowledge of regulations, policies, and best practice

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Independent and unrestricted RN license in the state of Michigan
• 3+ years of Managed Care Experience with LTSS focus
• 2+ years working with the HCBS waiver and LTSS/Personal Care
• Relevant clinical experience, often in areas such as long-term care, community mental health, developmental disabilities, or other specialized populations served by HCBS waivers
• Proficient computer and typing skills (reputed company and Outlook)
• Proven solid analytical, critical thinking, organizational and communication skills (both written and verbal)
• Access to high-speed internet at your home
• reputed company of Michigan
• Ability to work Monday - Friday, reputed company-5pm EST
• Driver's License and access to a reliable transportation

Preferred Qualification:

• Knowledge of LTSS and state appeals guidelines
• reputed company employees working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job