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RN | Medical Necessity Government Compliance Auditor

Macon, GA, United States
Job ID: 61515
Job Family: Nursing
Status: Full Time
Shift: Day
Job Type: Regular
Department Name: 12011053141601-Patient Access

Overview

Under the general direction of the Integrated Care Director, the RN Medical Necessity and Compliance Auditor coordinates, reviews, audits and refers cases assigned for medical necessity, clinical validation, RAC preparation, readmission review, etc.  The RN Gov. Auditor supports the physician providers and the multidisciplinary team in facilitating appropriate documentation for compliant, coding, medical necessity and clinical validation.   In addition, the RN Governmental Auditor acts as a liaison for utilization management and clinical documentation improvement by providing quality reviews with immediate feedback and education to Care Navigators, Nursing, Directors, Providers and other entities. 

 

Shift details: This position is full-time, 40hrs per week with rotating weekend and holiday coverage.  The schedule is Hybrid remote, with 1-2 days per week onsite.   Candidates must reside in the state of Georgia.

 

What we offer: 

  • Competitive pay 

  • Comprehensive Benefits (Medical, Dental, Vision, Health Savings and Spending Account options) 

  • 403b Retirement Savings Plan with employer-matching contributions 

  • Paid Time Off (PTO)

  • Tuition Assistance & Reimbursement Plans  

  • Employee discounts/perks 

  • Employee Fitness and Wellness Center 

 

What you will need: 

  • Associate's or Bachelor's degree in nursing, BSN preferred. 

  • Current valid Georgia nursing license or eNLC nursing license. 

  • Three (3) years recent experience in Utilization Review preferred.  

  •  Knowledge of Medicare and Medicaid medical necessity application to support compliant billing. Experience with IT solutions such as electronic health record, learning management or disease/care management systems a plus

  • Ability to work autonomously and be directly accountable for results.

  • Excellent written, verbal, and listening communication skills, positive relationship building skills, and critical analysis skills.  Presentation skills also a plus.

  • Must reside in the state of GA.