Note: The job is a remote job and is open to candidates in USA. Trend Health Partners is a tech-enabled payment integrity company focused on improving access to healthcare through collaboration between payers and providers. The Nurse Auditor I is responsible for performing medical necessity reviews of clinical documentation to ensure compliance with contracts, policies, and regulations.

Responsibilities

• Independently audit clinical documentation to ensure consistent with billed services in a production environment
• Apply clinical and industry guidelines, payer P&P, and use of in-depth knowledge that supports medically necessity of services rendered
• Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care
• Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly
• Share ideas that offer process improvements and share with team for education

Skills

• An active RN or LPN professional license in good standing
• 5 years of clinical practice
• Well-developed verbal and written communication skills coupled with recognizable organization
• Ability to effectively prioritize tasks
• Previous experience in medical auditing
• Experience in auditing or medical review
• Case Management and/or Utilization Review experience
• Experience in utilizing industry clinical guidelines

Benefits

• Competitive salaries
• Highly valued health insurance
• A 401(k) plan with employer match
• Paid parental leave

Company Overview