Job Summary
A provider of high-quality healthcare coverage to individuals and families is in need of a Work at Home RN or LPN Clinical Auditor.
Must be able to:
- Conduct, review, analyze and summarize findings of audit reviews for internal business units and delegated partners
- Perform audits on phone calls for staff to ensure quality and adherence to regulatory guidelines, policy and procedure
- Assist with evaluating and analyzing ad hoc quality performance data
Must meet the following requirements for consideration:
- Registered Professional Nurse (RN) license; AAS in Nursing if RN; or Licensed Practical Nurse(LPN)
- GED or HSD
- Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization
- Experience analyzing various types of data and processes with ability to present findings and recommendations
- Experience with an electronic shared network database
- Designated work area at the Telecommuting location away from the main flow of home traffic which meets OSHA and departmental policy with the ability to meet the technical requirements of the company
