Job Summary
A global healthcare company has an open position for a Telecommute Clinical Quality Nurse Auditor.
Core Responsibilities of this position include:
- Verifying that service providers were in network, or that a gap in network coverage was present
- Prioritizing services for medical chart review (e.g., high volume or high cost services)
- Identifying and reporting quality of care concerns appropriately
Skills and Requirements Include:
- 2+ years of experience in medical necessity or utilization management / review
- Experience in auditing or training of clinical teams
- Excellent written and verbal communication skills
- Experience with clinical criteria (MCG or InterQual)
- Experience in data analysis and reporting