Nurse Auditor - Remote Role - anywhere in USA job in New York at RCM Health Care Services

Job Description

Nurse Auditor - Remote Role
This is a fulltime position (40 hours per week) Monday - Friday. You will enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home. Covid Vaccination Not Require Since Remote Role.

Must be an RN and have managed care or health plan and auditing or utilization review experience!!!

Respected audit and medical management firm specializing in DRG clinical and coding validation with URAC accreditation in health utilization management and independent review. They are seeking a registered nurse with extensive experience in clinical auditing to perform a bill review and chart validation within our Hospital Bill Review Department.

Nurse Auditor
Position Summary
Candidate should be highly motivated, with strong clinical and auditing background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.
Responsibilities

• Must be detail oriented highly organized work skills
• Solid understanding of anatomy and physiology, diagnostic and surgical procedures
• Demonstrates the ability to accurately interpret what is transcribed in the medical record
• Writes clear, accurate and concise clinical notes in support of findings
• Maintains and manages case reviews with a high emphasis on quality
• Demonstrates the ability to work in a high - volume production environment
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Accurately interprets Plan policies and appropriately applies to the clinical audit
• Ability to communicate effectively both orally and in writing
• Complete appeal reviews when needed
• Demonstrates the ability to perform a level of care review utilizing Interqual guidelines
• Maintain and update hospital profiles as needed

• Must be a registered nurse with active RN license
• BSN or equivalent required
• 2-5 years auditing experience preferred, however will also consider Utilization Review, Managed
• Care, Case Management experience
• 2-5 years in either Medical Surgical or Critical Care experience required
• Ability to use Windows PC with the ability to utilize multiple applications at the same time
• Excellent computer skills
• Knowledge of appeals preferred
• Knowledge of CMS guidelines preferred