State Licensed Clinical Eligibility AuditorVirtualVocations • Pasadena, Texas, United States
State Licensed Clinical Eligibility Auditor
VirtualVocations • Pasadena, Texas, United States
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
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
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