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

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.