Registered Nurse Clinical Auditor

Job Summary

A company is looking for a Clinical Audit Specialist - Utilization Management.

Key Responsibilities

• Conduct retrospective and targeted audits of medical necessity determinations
• Analyze audit findings to identify trends and systemic issues in utilization management processes
• Collaborate with internal stakeholders to support compliance and process improvement initiatives

Required Qualifications

• Associates of Science (A.S) in Nursing (ASN) required; Bachelor of Science (B.S) in Nursing (BSN) preferred
• Five (5) years of clinical or related healthcare industry experience required
• Two (2) years of Utilization Management/Utilization Review experience required
• Demonstrated experience applying evidence-based criteria, including MCG and InterQual required
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required