Clinical Quality Nurse Auditor (Remote Registered Nurse)
Gainwell Technologies
- Oklahoma
- $75,000-115,000 per year
- Permanent
- Full-time
- Perform clinical reviews to determine if the medical record documentation supports the need for the service based on clinical criteria, coverage policies, and utilization and practice guidelines
- Conduct retrospective reviews, pre-certification and prior authorization; justify your findings by providing a documented rationale
- Determine approval or initiate a referral to a physician consultant; review the rationales provided for your reference and future use
- Enhance your knowledge by actively cross-training to review multiple claim types and clients to help Gainwell build a flexible, skilled workforce that meets diverse client needs
- Keep growing in your role by staying up to date on CEUs to maintain your RN license and coding certifications
- 5 or more years of experience working in an inpatient hospital setting and with 2+ years of experience analyzing and evaluating medical information, reviewing charts and applying clinical review guidelines to deliver accurate rationales
- Knowledge of clinical guideline criteria and best practices in clinical care, including possessing and maintaining an active and unrestricted RN license in your state of work
- Knowledge of Milliman or Interqual criteria and HIPAA privacy rules
- Strong written communication and analytical skills, with an emphasis on towards writing clear, accurate and concise clinical decision rationales in support of findings using a computer
- Strong team player with an ability to build relationships within the company and externally with clients as needed
- 100% work-from-home with occasional co-location with team (~1 time per month)
- Full-time (40 hours per week) Monday through Friday schedule
- Benefits start on first day of employment (medical, dental, vision)
- In order to effectively work as a remote worker (work from home) with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
- To Test your internet download and upload speed:
- Go to Google.
- Search for Internet Speed Test or click