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Job Description

Job Summary

This position is responsible for auditing of internal clinical decisioning, auditing of external provider IQ auto approvals, oversight of compliance reporting and mitigation of issues, Lead tester for system upgrades, trend identification and pilot implementation and review of prior authorization code subsets.

Initiates performance improvement studies in order to evaluate and measure the outcome of services. Make recommendations to improve the quality of services provided.

• Initiates performance improvement studies in order to evaluate and measure the outcome of services. Make recommendations to improve the quality of services provided.
• Oversees selected staff as assigned by manager to coordinate program services.

• Required LPN or RN
• Preferred Bachelors Degree or equivalent related field
• Experience in clinical auditing, management, reporting analytics
• Highly proficient in excel, tableau, , report creation

• LIC-Registered Nurse (RN) - STATE_MI State of Michigan Excludes CV Administration, HM Patient Care Logistics, Health Comm - Department, GM-Community Education, Lifestyle Medicine, PD HDVCH Child Protection, PH Medical Affairs Admin, PH Pre-Service Utility Management required Or
• LIC-License Practical Nursing (LPN) - STATE_MI State of Michigan required Or
• LIC-Master Social Worker (MSW-Master) - STATE_MI State of Michigan required Or
• LIC-Physical Therapist - STATE_MI State of Michigan required Or
• CRT-Occupational Therapist, Registered (OTR) - NB-COT National Board for Certification in Occupational Therapy required Or
• CRT-Speech Language Pathologist - ASHA American Speech-Language-Hearing Association required

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Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member’s job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here.