TREND Health Partners is seeking a qualified Nurse Auditor for our Provider Services team.

The Nurse Auditor’s primary responsibility is to perform medical necessity reviews of clinical documentation to determine the appropriateness of in-patient and outpatient services. Ensures the compliance of contracts, policy, procedures, guidelines, and regulations are well documented and properly executed into a compelling appeal argument with a 90 % overturn success rate.

This is a great opportunity to join a dynamic, employee-owned company that promotes a collaborative and innovative work environment. We offer a comprehensive compensation package which includes competitive salaries, highly valued health insurance, 401(k) with employer match, paid parental leave, and much more.

Applicants must be legally authorized to work in the United States on a full-time basis as TREND Health Partners is unable to provide sponsorship for visas. Additionally, TREND’s information security controls require that all workforce members reside within the United States.

Role and 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.
• Compile audit findings and formulate communication that conveys medical necessary services were ordered and provided warranting claim payment
• Collaborate with multiple departments
• 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 train others team members, accordingly

Qualifications

• Previous experience in medical auditing
• An active RN or LPN professional license in good standing
• 5 years of clinical practice
• 2-5 years of auditing or medical review experience
• Case Management and/or Utilization Review experience a plus
• Experience in utilizing industry clinical guidelines no less than 2 years
• Well-developed verbal and written communication skills coupled with recognizable organization, and prioritization abilities.