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IEHP

RANCHO CUCAMONGA, California

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University of Maryland Medical System

Baltimore, Maryland

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University of Minnesota Physicians

Minneapolis, Minnesota

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PIH Health

Downey, California

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Sonic Healthcare USA

Scottsdale, Arizona

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AdventHealth

Dade City, Florida

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Penn State Health

Hershey, Pennsylvania

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Southern California Permanente Medical Group

Simi Valley, California

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AdventHealth

Riverview, Florida

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AdventHealth

Riverview, Florida

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UNC Health

Holly Springs, North Carolina

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University of Maryland Medical System

Baltimore, Maryland

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Vanderbilt Health

Nashville, Tennessee

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Memorial Sloan Kettering Cancer Center

New York, New York

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CHRISTUS Health

Longview, Texas

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AdventHealth

Zephyrhills, Florida

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Pediatrix Medical Group

Seattle, WA, USA

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WMCHealth

Valhalla, New York

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Northeast Georgia Health System

Gainesville, Georgia

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Optum

Shippensburg, Pennsylvania

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AdventHealth

Riverview, Florida

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Pediatrix Medical Group

Texarkana, TX, USA

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Medical Auditor RN, (Utilization Review, Appeals)
JOB SUMMARYThis RN position primarily serves in the capacity of auditing and reviewing the "Appeals and Grievances" that our Scott and White Health Plans receive from a variety of sources.  While also referred to as the "Medical Nurse Auditor" from within our organization, the role is also expected to perform clinical reviews and provide input to our policies / procedures for our Medical Audit programs (associated with denials, appeals, grievances), insuring that our review and medical audit procedures are maintained, adhered to, and are compliant with state and national regulations.ESSENTIAL FUNCTIONS OF THE ROLEDevelops a multi-faceted audit plans, including for Diagnosis-Related Group (DRG) and Ambulatory P


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