RN Clinical Auditor

Job Summary

To support clinical auditing efforts, the full-time RN 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 based on clinical guidelines and severity of illness
• Utilizes proprietary auditing systems to make determinations and generate audit letters
• Maintains productivity and accuracy standards as set by audit operations management

Required qualifications

• Associate or Bachelor's degree in nursing
• Active RN License in the state of residence
• 5 to 7+ years of experience with InterQual/MCG and in Utilization or Case Management
• Critical Care background (ICU, Emergency Room, etc.) preferred
• Proficiency in Microsoft Office applications (Word, Access, Excel, TEAMS)