Clinical nurse rn Jobs in Norwalk, CA

A company is looking for a RN-Clinical Auditor 2.

Key Responsibilities

Performs audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews

Completes analysis of records against established criteria to determine compliance with patient care standards

Organizes and prioritizes multiple cases while maintaining confidentiality and adhering to HIPAA guidelines

Required Qualifications

Must be RN / Case Management / Utilization Review / Coding certified with a BS / BA preferred or equivalent experience

3 to 5 years of clinical or clinical auditing experience in case management, Medicare appeals, or denials management

Knowledge of Milliman (MCG) or InterQual criteria preferred

Experience in medical records review, claims processing, or utilization / case management

Proficiency in Microsoft Outlook, Word, Excel, and electronic documentation systems