Remote Clinical Readmission Auditor & Improvement Lead
Devoted Health
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Benefits offered by this job
Job summary
Devoted Health is seeking a Clinical Readmission Auditor to conduct prepayment and post-payment clinical reviews of inpatient admissions and related readmissions within 30 days of discharge. The role requires strong inpatient nursing knowledge, clinical judgment, and experience auditing hospital records.
You will apply policies and regulatory guidelines, document defensible findings, and support disputes and appeals.
Qualifications
- Active RN license in at least one US state.
- Bachelor's degree in nursing or related healthcare field.
- Experience reviewing inpatient readmissions and healthcare claims.
Responsibilities
- Conduct prepayment and post-payment clinical reviews of inpatient admissions and related readmissions within 30 days.
- Apply organizational policies, regulatory requirements, and readmission criteria consistently.
- Document clear, objective clinical rationales and supporting documentation.
- Prepare initial findings, dispute responses, and appeal documentation.
- Collaborate with clinical and internal teams on complex reviews.
- Maintain accurate records while protecting patient and provider information.
- Identify trends and opportunities to improve readmission review processes.
Skills
Education
Tools
Job description
Devoted Health is seeking a Clinical Readmission Auditor to conduct prepayment and post-payment clinical reviews of inpatient admissions and related readmissions within 30 days of discharge. The role requires strong inpatient nursing knowledge, clinical judgment, and experience auditing hospital records.
You will apply policies and regulatory guidelines, document defensible findings, and support disputes and appeals.
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