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Quality Improvement Specialist/Utilization Management Coordinator (UM) Coordinator jobs in United States
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State of Missouri · 18 hours ago

Quality Improvement Specialist/Utilization Management Coordinator (UM) Coordinator

The State of Missouri is dedicated to the prevention and treatment of mental illness and developmental disabilities. They are seeking a Quality Improvement Specialist/Utilization Management Coordinator to conduct various reviews and audits related to utilization management, ensuring quality standards are met.
AgricultureGovernmentInformation Technology

Responsibilities

Conduct Admission UM Reviews
Conduct Transfer UM Reviews
Audit Continued Stay Reviews
Review Declining Patient Reports
Review Critical Lab Reports
Review CIMOR Admit ORYX-Admissions (for NRI)
Review CIMOR Discharge ORYX-Discharges (for NRI)
Conduct Transition of Care Audits (includes medical, jail, court, discharges)
Review Patient Transfer and Physician Order Form
Compile Admission Stats
Compile Admission Stats for APS
Conduct Medical Record Reviews
Conduct Open and Closed Billing Audits-(Monthly)
Prepare Utilization Review Reports
Lead UM and Corporate Compliance meetings
Assist with other assigned Quality Management audits

Qualification

Quality Improvement PlansAccreditation Standards KnowledgeMedical Billing UnderstandingClinical/Medical ExperienceTeam Collaboration

Required

Master's degree, but individuals with a bachelor's degree will be considered who have years of clinical/medical experience
Knowledge of accreditation and certification standards and their application to state or privately operated facilities
Ability to formulate quality improvement plans to improve efficiency
Understanding of medical billing and practices is a plus

Benefits

Defined pension plan
Generous amounts of leave and holiday time
Eligibility for health insurance coverage

Company

State of Missouri

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The State of Missouri is a group of outstanding people that accomplish extraordinary things for our folks every day.

Funding

Current Stage
Late Stage

Leadership Team

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Kevin Mccarthy
Chief Technology Officer
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Jennifer Tidball
Chief Operating Officer at Missouri Department of Social Services
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