Auditor Clinical Validation (Place of Service, Short Stay & Readmission)

About This Gig

Overview This auditing role will be responsible for performing retrospective clinical chart reviews on Readmission and Place of Service Claims by utilizing nationally accepted guidelines, clinical review judgment and review methodologies specific to the contract for which services are being provided. This involves accessing proprietary systems to audit medical records, applying critical thinking and decision-making skills, and accurately documenting a rationale with the findings and supporting references. The ideal candidate for this role would be a Registered Nurse with experience in utilization or case management. This role will start on 8/3/2026 and will be in training throughout the rest of August until mid September (no time off during this time). Responsibilities Analyzes and Audits Claims. Integrates medical chart severity of illness and intensity of service based on clinical guidelines and objectivity in performance of medical audit activities. Effectively Utilizes Audit Tools

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