New9h ago
- Specialty: Utilization Review
- Job type: Full-time
- Salary: $80,000 – $120,000
- License states: Maryland
RemoteBehavioral Health+2
Job details- Utilization Review
- Full-time
- $60,000 – $90,000
- License: Maryland
- 3+ years
Job description
Conducts clinical audits of behavioral health providers to ensure compliance with regulatory and contractual requirements. Reviews medical records, claims, and documentation to identify overpayments, underpayments, and quality of care issues. Prepares audit reports and communicates findings to providers. Works remotely with occasional travel within Maryland.
Key responsibilities
- Perform clinical audits of behavioral health providers
- Review medical records and claims for compliance
- Prepare audit reports and communicate findings
- Identify overpayments, underpayments, and quality issues
What you bring
- Active unrestricted RN license in Maryland
- 3+ years clinical experience in behavioral health
- Knowledge of Medicaid/Medicare regulations
- Strong analytical and communication skills
Tags
RemoteBehavioral HealthAuditorMaryland
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