Licensed Nurse Auditor

Job Summary

A company is looking for a Nurse Auditor (Clinical Appeals).

Key Responsibilities

• Conduct audits and review medical records to support appeals for denied services
• Prepare clinical reconsideration/appeal letters based on evidence from patient records
• Perform various denial reviews related to authorization, medical necessity, and charge audits

Required Qualifications

• Registered Nurse or Licensed Vocational Nurse
• Experience in Utilization Review and Case Management
• Familiarity with InterQual and/or MCG
• Inpatient clinical experience required
• Access to a home internet connection that meets specified criteria for remote work