Training, Development, and Mentoring:
- Assess job-specific needs and develop technical training plans with clear business objectives.
- Deliver specific training sessions using suitable delivery methods such as classroom, online, and webinar.
- Identify the development needs of others and coach, mentor, or otherwise assist others with improving their knowledge skills.
Quality Assurance Controls:
- Integrate healthcare auditing principles and use objectivity in the performance of medical audit activities and reviews.
- Review and interpret audit work of others, apply in-depth knowledge of clinical criteria to determine medical necessity.
- Provide feedback on reviews to the Quality Assurance Manager as indicated to improve rationales sent to providers.
New Concepts and Processes:
- Develop reasonable and effective recommendations for concept solutions that reflect understanding of client environment and risks.
- Suggest and develop new ideas, approaches, decision trees, and/or technological improvements to optimize audit results.
- Collaborate with Data Services in developing new reports.