Registered Nurse Clinical Compliance Auditor

Key responsibilities: Conduct comprehensive clinical compliance audits and monitor adherence to utilization management and population health management plans Perform routine and ad hoc audits to assess compliance with internal policies and regulatory standards Provide mentorship and guidance to Clinical Compliance Auditors and support leadership in identifying training needs

Required qualifications: Active, unrestricted Registered Nurse (RN) license Strong knowledge of utilization management processes and regulatory compliance requirements Minimum of 3-5 years of experience in utilization management, clinical auditing, or managed care Knowledge of Medicare and commercial managed care compliance requirements Proficiency with Microsoft Office, including Excel and reporting tools