Registered Nurse Clinical Auditor

Job Summary

A company is looking for an Auditor Clinical Validation (Place of Service, Short Stay & Readmission).

Key Responsibilities

• Analyzes and audits claims based on clinical guidelines and medical chart severity
• Utilizes proprietary auditing systems to make audit determinations and generate audit letters
• Maintains productivity and accuracy standards set by the audit operations management team

Required Qualifications

• Associate or Bachelor's degree in nursing
• Active and unrestricted RN License in state of residence
• 5 to 7+ years of experience in Utilization Management and/or Case Management
• Critical Care background, such as ICU, Emergency Room, or Med Surg
• Proficiency in Word, Access, Excel, TEAMS, and other applications