Licensed RN Clinical Auditor

Job Summary

Working remotely or onsite, the full-time Licensed RN Clinical Auditor will review and audit medical necessity justifications for air and ground ambulance transports, evaluate and submit medical necessity appeals for commercial payors, and ensure compliance with established clinical standards.

Key responsibilities

• Conduct audits of medical necessity appeals for various payor sources while advocating for the patient and the organization
• Ensure timely processing of appeals and maintain updates in the appeals database
• Collaborate with the Appeal team to maximize claim reimbursements and minimize financial risks associated with clinical denials

Required qualifications

• Current RN licensure with a minimum of five years of experience in Emergency Department, ICU, flight, or ambulance settings
• Some supervisory or leadership experience preferred, such as team leader or charge nurse
• Proficiency in Microsoft Word, Excel, and Office 365
• Bachelor's degree in nursing or equivalent preferred
• CFRN, CEN, or CCRN certification preferred