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 of illness and intensity of service based on clinical guidelines
- Utilizes proprietary auditing tools to make determinations and generate audit letters effectively
- Maintains production and quality standards 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 Management 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
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