Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor for Utilization Management Operations in Remote USA.

Key Responsibilities:

• Develop audit tools and conduct audits to ensure compliance with regulatory and operational standards
• Prepare audit findings and propose action plans for improvement
• Provide orientation and training programs to ensure consistent performance within plan standards

Qualifications:

• 3+ years of experience in health plan operations, preferably in Medicare
• Experience in healthcare payer working in UM and/or audit operations
• Knowledge of Medicare Compliance is a plus
• Unrestricted RN or LVN/LPN license is a plus
• Ability to multitask and adapt in a fast-paced environment