Clinical Manager - Payment Integrity
Job Summary
To enhance payment integrity processes, the full-time Clinical Manager - Payment Integrity will oversee clinical audits, ensure compliance with regulations, and collaborate with cross-functional teams in a remote environment.
Key responsibilities
- Manage and conduct clinical audits to ensure adherence to payment integrity standards
- Collaborate with internal teams to address compliance issues and implement corrective actions
- Develop and maintain documentation related to payment integrity processes and findings
Required qualifications
- Registered Nurse (RN) or equivalent clinical experience
- Experience in payment integrity, claims review, or healthcare compliance
- Strong understanding of clinical guidelines and regulatory requirements
- Proven ability to lead projects and work collaboratively in a remote setting
- Relevant certifications in healthcare auditing or compliance preferred
Complete Job Description
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