Job Summary
A health insurance company is filling a position for a Telecommute Clinical Quality RN Auditor.
Must be able to:
- Evaluate pre-certification case review and medical claims case review
- Verify that service providers were in network, or that a gap in network coverage was present
- Follow relevant regulatory guidelines, policies and procedures
Position Requirements Include:
- Unrestricted Registered Nursing License
- 2+ years of experience in medical necessity or utilization management / review
- 2+ years of medical claims review post service or 2+ years of prior authorization experience
- Experience in auditing or training of clinical teams
- Excellent written and verbal communication skills
