A company is looking for an Auditor Clinical Validation (Place of Service, Short Stay & Readmission).
Key Responsibilities
Analyze and audit claims based on clinical guidelines and medical chart severity
Utilize proprietary auditing systems to make determinations and generate audit letters
Maintain production goals and achieve accuracy and quality standards for audits
Required Qualifications
Associate or Bachelor's degree in nursing
Active RN License in the state of residence
5 to 7+ years of experience in Utilization Management or Case Management
Critical Care background in areas such as ICU, Emergency Room, or Med Surg
Proficiency in Word, Access, Excel, and TEAMS