Clinical RN I – Pre/Post Pay Audit in Remote

Location

Remote

Job Type

Contractor

Company

Integrated Resources, Inc

Role: Clinical RN I – Pre/Post Pay Audit Location: Remote (NJ, NY, PA, CT, DE) Job Summary Performs pre- and post-pay clinical audits to ensure documentation accuracy, authorization validation, and compliance with medical necessity criteria. Follows defined guidelines and escalates as needed. Key Responsibilities Conduct pre/post-pay audits using standard guidelines Review claims, clinical documentation, and authorizations Compare cases against MCG criteria Document findings and update audit trackers Identify gaps and escalate issues as required Ensure compliance with audit standards and policies Tools & Systems Excel, ECM/DMS (ITS), Care Radius, MCG Outlook / Teams Requirements Active RN license (unrestricted) ASN or BSN Experience in utilization review, clinical audits, or documentation review Strong attention to detail and documentation accuracy Preferred Pre/post-pay audit experience Familiarity with MCG criteria and audit systems Experience with regulatory/state audits Remote

Skills: Auditing, Clinical Study Publications, Detail Oriented, Documentation, Documentation Review, Engineering Change Management, Information Technology/Systems Audit, Maintain Compliance, Microsoft Outlook, Patient Care Authorizations, RADIUS (Remote Authentication Dial-In User Service), Registered Nurse (RN), Regulatory Compliance, State Laws and Regulations, Utilization Management

About the Company: Integrated Resources, Inc