RN Clinical Auditor

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)