Remote RN Auditor - Clinical Validation & Utilization

Cotiviti; Northern (KY); Hybrid; USD 90,000 - 100,000; Full time

Benefits offered by this job

Medical, Dental, Vision insurance

401(k) savings plans

Paid time off & holidays

Job summary

Cotiviti is seeking a senior auditing RN to perform retrospective chart reviews on Readmission and Place of Service Claims, applying clinical guidelines and considering claims-specific contracts. The role requires strong documentation, decision-making, and proficiency with Cotiviti auditing systems.

The ideal candidate has 5–7+ years in Utilization/Case Management with an ICU/CCU background, and holds an RN license with active state credentials.

Qualifications

• Registered Nurse with active/unrestricted license in state of residence.
• 5 to 7+ years of experience in Utilization/Case Management.
• Experience with InterQual/MCG (Inpatient vs Observation).
• Proficiency in Word, Excel, Access, TEAMS and similar tools.

Responsibilities

• Audits and analyzes claims; integrates severity of illness and service intensity per guidelines.
• Uses Cotiviti proprietary auditing systems to determine audits and generate letters.
• Meets production goals set by audit operations management.
• Maintains accuracy and quality in audit documentation and letters.
• Identifies new claim types; suggests process improvements.
• Completes annual Performance Plan tasks and special projects.

Skills

InterQual/MCG

Utilization Management

Case Management

Clinical auditing

Education

Associate or Bachelor's degree in nursing

RN License (active/unrestricted)

Case Management Certification (preferred)

Tools

Word

Access

Excel

TEAMS

Job description

Cotiviti is seeking a senior auditing RN to perform retrospective chart reviews on Readmission and Place of Service Claims, applying clinical guidelines and considering claims-specific contracts. The role requires strong documentation, decision-making, and proficiency with Cotiviti auditing systems.

The ideal candidate has 5–7+ years in Utilization/Case Management with an ICU/CCU background, and holds an RN license with active state credentials.