RN Compliance Auditor — Remote (NC)

Trillium Health Resources; North Carolina; Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Health Insurance and PSLF eligibility

Work-from-home options

PTO and holidays

401k with match

Job summary

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine compliance, and direct corrective actions to prevent improper payments and support program integrity.

On a typical day, you will conduct clinical reviews of pre- and post-payment claims, evaluate documentation against policies, manage cases from intake

Qualifications

• Must have an Associate's degree in Nursing.
• Active North Carolina Licensure as a Registered Nurse (RN).
• Must have a valid driver\'s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Responsibilities

• Conduct clinical reviews of pre- and post-payment claims to verify compliance.
• Evaluate clinical documentation against coverage policies and service definitions.
• Apply independent clinical judgment to determine compliance and identify discrepancies.
• Manage assigned compliance cases from intake through resolution.
• Investigate allegations of non-compliance.
• Evaluate case findings and determine appropriate corrective actions.
• Maintain complete case files in accordance with regulatory and accreditation standards.

Skills

Clinical judgment

Documentation review

Compliance investigations

Case management

Regulatory awareness

Education

Associate's degree in Nursing

Active NC RN licensure

Job description

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine compliance, and direct corrective actions to prevent improper payments and support program integrity.

On a typical day, you will conduct clinical reviews of pre- and post-payment claims, evaluate documentation against policies, manage cases from intake