Tennessee Licensed Nurse Auditor

Job Summary

A company is looking for a Nurse Review Auditor (REMOTE).

Key Responsibilities

• Review, analyze, and resolve high-complexity claims and denials requiring advanced clinical judgment
• Determine appropriate admission type, level of care, and coverage based on clinical documentation
• Document opinions and compose clinical appeals with supporting documentation from recognized sources

Requirements and Qualifications

• Active RN license with ADN or BSN required; Compact State licensure preferred
• Minimum of 2 years' experience in medical necessity reviews and admission/length of stay evaluations
• 3-5 years' acute care hospital experience in areas such as ICU/Trauma or Surgery
• Strong knowledge of payer policies and CMS guidelines
• Professional coding credentials (e.g., CPC, CCS) and technology proficiency in EMR/EHR systems are a plus