Clinical Quality Assurance Nurse Auditor (32604)
Summary
A registered nurse with ICU experience reviews medical records, reports, and billing for clinical accuracy and regulatory compliance, ensuring evidence-based standards and protecting healthcare integrity.
*** All candidates must reside in the Pacific or Central Time Zone. You must also be a Registered Nurse (RN) with an active license and have ICU experience. ***
Why Join Us?
Are you a meticulous RN who loves diving into clinical data? Do you want to use your medical expertise outside of direct patient care to impact healthcare integrity?
As our Clinical Quality Assurance Nurse Auditor, you will be the final line of defense for medical accuracy and compliance. Your expertise ensures that clinical reports, medical record chronologies, and billing reviews are bulletproof, evidence-based, and of the highest professional standard. This is a high-impact role where your sharp clinical eye directly protects patients, providers, and healthcare standards.
What You Will Do (Your Impact)
- Champion Report Excellence: Review and refine critical medical reports, chronologies, and provider bills to ensure flawless clinical accuracy and professional presentation.
- Uphold Evidence-Based Medicine: Verify that every clinical determination is backed by robust, current citations from reputable medical journals.
- Act as a Strategic Partner: Collaborate directly with reviewing physicians to clarify complex case details and resolve inconsistencies.
- Guard Compliance & Integrity: Ensure full alignment with federal ERISA regulations, state mandates, and client specifications, while strictly verifying that no conflicts of interest exist.
- Solve Problems Proactively: Help resolve client quality questions, recover missing medical data, and provide management with strategic insights on consultant performance.
What You Bring to the Team
- Clinical Expertise: Active Registered Nurse (RN) license with strong clinical judgment.
- A Sharp Eye for Detail: Exceptional proofreading, auditing, and analytical skills.
- The Ability to Connect Dots: Deep understanding of medical coding, hospital billing, and record chronologies.
- Regulatory Knowledge: Familiarity with state and federal healthcare mandates (like ERISA) is a massive plus.
- Communication Skills: Ability to give constructive feedback to medical peers and providers with professionalism and clarity.
Organ donations
Organ Procurement
Intensive Care Unit (ICU)
