Registered Nurse Clinical Auditor

Job Summary

To support clinical auditing efforts, the full-time Registered Nurse Clinical 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 by integrating medical chart severity and intensity of service based on clinical guidelines
• Utilizes proprietary auditing systems to make determinations and generate audit letters effectively
• Maintains production and accuracy goals 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 in Utilization Management and/or Case Management
• Working knowledge of InterQual/MCG standards
• Proficiency in Microsoft Word, Access, Excel, and TEAMS