Registered Nurse Auditor
Job Summary
To support clinical auditing efforts, the full-time Registered Nurse Auditor will perform retrospective chart reviews on Readmission and Place of Service Claims, utilizing clinical guidelines and proprietary systems, while maintaining productivity and accuracy standards.
Key responsibilities
- Analyzes and audits claims based on clinical guidelines and severity of illness
- Utilizes proprietary auditing tools to make determinations and generate audit letters
- Maintains productivity and accuracy standards as set by the audit operations management team
Required qualifications
- Associate or Bachelor's degree in nursing
- Active and unrestricted RN License in the state of residence
- 5 to 7+ years of experience with InterQual/MCG and in Utilization or Case Management
- Critical Care background in areas such as ICU, Emergency Room, or Med Surg
- Proficiency in Word, Access, Excel, TEAMS, and other applications
Complete Job Description
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