Registered Nurse Clinical Compliance Auditor

Job Summary

To ensure adherence to regulatory requirements and internal clinical standards, the full-time remote Registered Nurse Clinical Compliance Auditor will conduct comprehensive audits, monitor compliance with utilization management plans, and provide mentorship to clinical compliance staff.

Key responsibilities

• Conduct comprehensive clinical compliance audits and monitor adherence to utilization management and population health management plans
• Perform routine and ad hoc audits to assess compliance with internal policies and regulatory standards
• Provide mentorship and guidance to Clinical Compliance Auditors and support leadership in identifying training needs

Required qualifications

• Active, unrestricted Registered Nurse (RN) license
• Strong knowledge of utilization management processes and regulatory compliance requirements
• Minimum of 3-5 years of experience in utilization management, clinical auditing, or managed care
• Knowledge of Medicare and commercial managed care compliance requirements
• Proficiency with Microsoft Office, including Excel and reporting tools