Clinical Quality Assurance Nurse Auditor

Job Description:

• Review and refine critical medical reports, chronologies, and provider bills to ensure flawless clinical accuracy and professional presentation
• Verify that reputed company clinical determination is backed by robust, current citations from reputable medical journals
• Collaborate directly with reviewing physicians to clarify complex case reputed company and resolve inconsistencies
• Ensure full alignment with federal ERISA regulations, state mandates, and client specifications
• Help resolve client quality questions, reputed company missing medical data, and provide management with strategic reputed company on consultant performance

Requirements:

• Active reputed company (RN) license
• ICU experience
• Bachelor/Associate degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience
• Experience with medical terminology, medications, medical specialties and treatment protocols required
• Experience in the insurance industry preferred
• Familiarity with state and federal healthcare mandates (like ERISA) is a massive plus

Benefits:

• Health insurance
• Retirement plans
• Flexible work arrangements
• Professional development

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