The Clinical Quality Assurance Nurse Auditor is responsible for evaluating clinical information received from various healthcare providers and writes various reports based on the clinical information received. This position ensures reports are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates. This position is required to handle quality assurance questions and provide overall support to the Quality Assurance Department.
This position will require two days in the Redding office and allows you to work from home three days per week!
ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:
EDUCATION AND/OR EXPERIENCE
Bachelor 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.
CERTIFICATES, LICENSES, REGISTRATIONS
Registered Nursing license required.
CPC experience ideal.
Previous case management or utilization experience preferred.