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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.
Essential FunctionsPrimary Location
SITE - Priority Health - 1231 E Beltline - Grand RapidsDepartment Name
PH - Pre-Service Utilization ManagementEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
40/weekDays Worked
M-FWeekend Frequency
N/ASpectrum 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.
Spectrum Health
Grand Rapids, MI