Under the direction of the Utilization Management (UM) Supervisor or above, this position will
conduct audits of assigned areas, assist in department audit initiatives as well as perform audits
in accordance with the department audit plan. As an integral member of the Training and
Development Team, this position will help the audit function keep pace with the audit needs of
the UM Department.

▪ Performs assigned duties and tasks in accordance with department audit policies and
standards.
▪ Follows defined audit methodology, taking the initiative to continually improve
execution and make improvement recommendations.
▪ Identifies and acts on opportunities to use tools and techniques to improve quality and
efficiency of audits.
▪ Executes audit activities and constructs draft deliverables in a way that contemplates
executive interest and reactions to observations; seeks coaching and information to
develop an understanding of management’s viewpoints and expectations.
▪ Proactively manages individual work assignments to meet schedule requirements.
▪ Develops first drafts of issues, reports, and other deliverables.
▪ Provides department leadership with recommendations regarding issue
categorization/severity; provides recommendations regarding key messaging in audit
reports.
▪ Identifies weaknesses and gaps in department quality controls and elevated risk areas.
▪ Drafts and communicates audit recommendations, individual staff reports and other
written reports as needed.
▪ Provides independent evaluations of documentation quality, staff and department
productivity, operational and financial controls, regulatory compliance, and risk areas.
▪ Performs and coordinates follow-up audits to determine if management has taken action
to mitigate risks identified.
▪ Assists in training and education opportunities to bring audit findings to leaders, staff,
and other organizational stake holders.
▪ Participates in special reviews as necessary.
▪ Represents department audit’s goals, objectives, and viewpoints in collaborating with
management and business constituents.
▪ Drives department audit initiatives, special projects, and improvement initiatives, as
assigned.

▪ Provides input during all phases of risk assessment and annual audit planning and
execution.
▪ Applies industry standard audit procedures and documents findings in work papers in
accordance with professional standards and department audit policies and standards.
▪ Participates in meeting the objectives of the department audit training program; executes
against agreed upon development goals.
▪ Assists in defining initial engagement scope and objectives.
▪ Documents audit work; designs initial audit work programs, testing strategies, and
detailed testing procedures.
▪ Performs reviews of assigned work paper sections, drafts audit reports, etc., as part of the
quality assurance and improvement program.
▪ Assists in collaborating with department leaders to fully understand their process and
assists with getting to the root cause of identified deficiencies.
▪ Assists in conducting regular presentations to business units to announce audit kickoff
activities and to communicate audit findings.
▪ Researches the topic to be audited and document/ catalogue regulatory and contractual
standards governing each audit area.
▪ Keeps abreast of company policies and procedures, current developments in managed
care, utilization review/case management, and changes in state and federal laws and
regulations, as applicable.
▪ Mentors and educates seasoned and new staff with regards to department policies,
practices, and operations.
▪ May provide back-up to other positions as required.
▪ Performs other duties as assigned.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$118,518.94 - $154,074.63

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.