Average salary: $97,884 /yearly
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$37.5 - $40 per hour
...responsible for ensuring regulatory compliance related to Utilization Management (UM) and Case Management (CM) activities. The CQM Nurse auditor reports directly to the CQM Manager. CQM nurse duties include, but are not limited to, performing UM process related internal...SuggestedHourly payFull timeCasual workRelocation packageFlexible hoursRegal Medical Group
Canoga Park, CA1 day ago$78.4k - $107.8k
Become a part of our caring community and help us put health first The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and coding for services rendered is complete, compliant, and accurate to support optimal reimbursement...SuggestedBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...experience in using billing and claims forms (UB, CMS, and HCFA). Normally to be proficient in the competencies listed above: •Nurse Auditor would have a/an Associate or Bachelor’s Degree in Nursing or related field and 5 years of hospital quality management, coding or...SuggestedWork at officeRemote work
- ...service to our affiliated Universal Health Services hospitals. The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case management experience to be responsible for analyzing clinical claim denials, drafting detailed appeal letters...SuggestedWork at officeLocal area
- RN Nurse Auditor page is loaded## RN Nurse Auditorlocations: Charlestontime type: Full timeposted on: Posted Todayjob requisition id: R-0000047288**Job Description Summary**The RN Nurse Auditor is a key member of the Clinical Appeals team and reports directly to the Clinical...SuggestedShift workRotating shift
- Position Overview Assists with the daily coordination of personnel and resources within a clinical specialty or department. Reports to: Director Patient Financial Services FLSA: Exempt Minimum Qualifications Education: Associate's degree required; Graduate of a Program...SuggestedWork experience placement
- ...getting results the right way, and fostering continuous learning. Your Knowledge and Experience ~ Bachelor's of Science in Nursing or advanced degree preferred ~ Current, unrestricted California Registered Nurse (RN) license required ~5 years of relevant...SuggestedWork at office2 days per week
Blue Shield of CA
San Diego, CA3 days ago - ...mentioned here, but considered related are not essential functions. Job Qualification 1. Graduate from an accredited School of Nursing. Bachelor's Degree in Nursing, required, or equivalent combination of education and related experience. 2. Current License to...SuggestedHourly payDaily paidRemote work
FlexStaff Careers
Garden City, NY3 days ago - ...A leading healthcare company is seeking a Nurse Auditor 2 to perform clinical audits and ensure that medical documentation is compliant and accurate for optimal reimbursement. The role requires an active RN license and a minimum of 2 years of acute inpatient experience...SuggestedRemote work
Humana
Jackson, MS3 days ago - ...RN Nurse Auditor Charleston, South Carolina The RN Nurse Auditor is a key member of the Clinical Appeals team and reports directly to the Clinical Appeals Manager. This role is responsible for conducting clinical reviews of payer audit determinations, identifying...SuggestedRotating shift
- ...with regulatory, contractual, and NCQA requirements. Serve as auditor-in-charge for large and complex audits, providing direction and... ...Your Knowledge and Experience ~ Bachelor's of Science in Nursing or advanced degree preferred ~ Current, unrestricted...SuggestedFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
Blue Shield Of California
Long Beach, CA1 day ago - ...of the problem and maintains monthly reporting that track and compare patterns of delegated entities. The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this role you will be assist in maintaining continuous quality improvement...SuggestedWork at office2 days per week
Blue Shield of CA
Long Beach, CA3 days ago - Compliance Auditor - Nurse (2604178) Description Job Purpose The Compliance Auditor (CA) reports directly to the Vice President of Compliance (VPC) to conduct compliance audits for Health Care Centers (HCC), Hospice, Home Health and/or SOURCE/CCSP service lines. The CA...SuggestedFlexible hoursShift work
- A local healthcare provider in Fort Wayne is seeking a qualified Medical Record Reviewer (QA Nurse) to ensure compliance and quality of clinical documentation. This role involves performing audits, providing feedback to nursing staff, and documenting deficiencies, with...SuggestedWork at officeLocal areaMonday to Friday
$47.95 - $71.93 per hour
...manager for follow‑up; and maintain communication with external auditors. Review and analyze audit reports/RAC findings, investigate... ...improvement. Full Time / Days Qualifications: Associate’s degree in nursing required; Bachelor’s degree preferred. Current licensure as a...SuggestedHourly payFull timeFor contractorsLocal areaImmediate startShift work- ...Reviewer in Fort Wayne. The ideal candidate will oversee the accuracy and completeness of clinical documentation, perform audits of nursing records, and provide crucial feedback to nursing staff. This role requires an active RN license in Indiana and offers a Monday-...Work at officeMonday to Friday
Registered Nurse - Diagnosis Related Group (DRG) Coding Auditor Principal - Carelon Payment Int[...]
$113.77k - $215.57k
Registered Nurse - Diagnosis Related Group Coding Auditor Principal - Carelon Payment Integrity Location: Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance...Daily paidWork at officeLocal areaRemote work1 day per week- A prestigious medical center in Bellevue, United States is hiring for a nursing role focused on coordinating Medicare audits and maximizing reimbursement. Candidates must have an Associate's degree in nursing and be a licensed RN in Washington. The position requires at...
- A healthcare organization located in Bellevue is seeking a full-time Nurse Billing Auditor. The role involves coordinating audits related to Medicare and Medicaid programs, analyzing clinical payment denials, and ensuring proper reimbursement for services rendered. Candidates...Full time
$67.1k - $102.46k
...Hybrid Remote Rn-Nurse Auditor For Hcc Program Management Department Presbyterian is seeking a hybrid remote RN-nurse auditor for the Hcc Program Management Department. This role will support the hierarchical condition categories (hcc) processes for pmg and ahwa clinics...Full timeRemote workShift work- A leading healthcare company in Des Moines seeks a Nurse Auditor 2 to perform clinical audits, ensuring accurate medical record documentation and coding. This remote position involves interpreting medical documentation, validating provider codes, and requires a current...Remote job
$78.4k - $107.8k
A healthcare services provider is looking for a Nurse Auditor 2 to ensure accurate medical coding and documentation. This remote position involves validating medical records, reviewing claims, and addressing fraud waste concerns. Candidates should hold an RN license, have...Remote job- A leading healthcare provider is seeking a DRG Nurse Auditor in Richmond, Virginia. This role involves analyzing clinical claim denials, drafting detailed appeal letters, and performing DRG validation reviews. Candidates should possess an RN or LPN license, ideally with...
- A healthcare organization is seeking a Nurse Researcher Assessor/Auditor to work from Frankfort, Kentucky, and telecommute. The ideal candidate will be a registered nurse responsible for conducting waiver audits and ensuring compliance with Medicaid regulations. This position...Remote job
- A health care organization is seeking a Compliance Auditor in Georgia. The position reports to the Vice President of Compliance and involves... ..., Hospice, Home Health, and related services. A Registered Nurse license is required, along with strong analytical and communication...
- ...healthcare organization in Norcross, Georgia, is seeking a Compliance Auditor to conduct internal compliance audits across various healthcare service lines. The ideal candidate must be a Registered Nurse with knowledge of federal regulations and possess strong analytical...
- A leading company seeks a Special Project Nurse/Medical Professional responsible for auditing and reviewing medical records to support quality improvement and HEDIS data collection. The ideal candidate will have RN/LPN credentials with extensive clinical and HEDIS experience...
- ...RN Clinical Auditor Responsible for conducting comprehensive review of claim data and/or medical record documentation related to Fraud... ...Qualifications Qualifications Required: Registered Nurse with an active, current, unrestricted license in RI in good standing...Contract workWork at office
$78.4k - $107.8k
Become a part of our caring community and help us put health first The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and coding for services rendered is complete, compliant, and accurate to support optimal reimbursement...Bi-weekly payFull timeTemporary workApprenticeshipRemote workHome officeMonday to Friday- ...A leading health insurance provider is looking for an experienced Delegation Operations Nurse Auditor in Los Angeles, CA. This role focuses on auditing Utilization Management processes, identifying issues, and ensuring compliance with organizational goals. Candidates should...Work at office
Blue Shield of CA
Los Angeles, CA2 days ago
