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For your reference, we have included the original job posting below.
Assistant Director Review Operations ? Medicaid Integrity Program
Job Number:
26848286
Company Name:
IPRO
Job Location:
Tampa, FL US
Job Category:
Healthcare & Medical
Minimum Education:
4-Year College Degree
Assistant Director Review Operations ? Medicaid Integrity Program
About IPRO
As a leading health care consulting organization, IPRO provides a full spectrum of health care assessment and improvement services with the goal of improving health care for the common good.
Founded in 1984, IPRO holds contracts with federal, state, and local government agencies and private organizations. IPRO operates programs in more than 33 states and the District of Columbia, and currently supports over 50 government health care programs.
Assistant Director Review Operations ? Medicaid Integrity Program
This individual is responsible for ensuring that case reviews are completed in accordance with federal and state guidelines and are conducted in a timely, efficient and effective manner. This individual will supervise clinical case review staff to assure uniform and consistent determinations. This position will be located in Tampa, Florida
Qualifications: - Florida Licensed RN required. - Strong communication (both written and verbal) skills with the ability to present clinical data/findings to interested parties with varying backgrounds. - Strong interpersonal skills with the proven ability to effectively manage, and successfully work with, clinical and non-clinical staff. - Strong time management skills with the ability to meet client deliverables/deadlines. - Knowledge of Florida Medicaid fraud and abuse and/or program integrity preferred. - The ability to travel as needed.
Education & Experience: - A Bachelor?s degree in Nursing (Master?s preferred) or a graduate of an approved Registered Professional training program required. - Minimum of five (5) years of experience in medical record/utilization review that includes the identification of medical necessity and/or quality of care issues with at least two years of experience auditing claims for medical services for various types of medical providers. - Previous experience with InterQual or Milliman Criteria and/or utilization management preferred. - Previous experience supervising and managing medical review projects preferred.
While we are grateful for all interest expressed in employment with IPRO, only candidates being considered for an interview will be contacted.
IPRO is looking for talented health care professionals and individuals with experience in the health care industry. IPRO is an Equal Opportunity/Affirmative Action Employer; M/F/D/V.
