State Licensed Clinical Eligibility Auditor

A company is looking for a Clinical Eligibility Auditor to support Medicaid program integrity audits.

Key Responsibilities

Conduct detailed reviews of Medicaid and CHIP eligibility determinations for compliance

Apply clinical judgment to complex eligibility cases and assess state Medicaid policies

Prepare audit reports summarizing findings and collaborate with state agencies on eligibility decisions

Required Qualifications

Active, unrestricted Registered Nurse (RN) license

Bachelor of Science in Nursing (BSN) required; Master's degree preferred

Minimum 3 years of professional nursing experience, preferably in Medicaid-related work

Experience with Medicaid and / or CHIP programs is strongly preferred

Proficiency in Microsoft Office applications and experience in reviewing clinical records