RN Quality Auditor II — Claims & Compliance

Healthcare Support Staffing; Trenton (NJ); On-site; USD 60,000 - 80,000; Full time

Job summary

A national healthcare staffing firm is seeking a qualified professional in Trenton, NJ, responsible for the quality review of claims and managing in-service clinical programs. A valid RN License in NJ and a Bachelor's degree are required, along with three years of clinical nursing and audit experience. The successful candidate will perform audits, maintain quality records, and respond to customer complaints, contributing to regulatory compliance and operational effectiveness. Competitive opportunity with a focus on experience and quality.

Qualifications

• 3 years clinical nursing experience.
• 3 years audit experience.
• Knowledge of NCQA compliance.

Responsibilities

• Perform quality review of claims.
• Coordinate clinical and nursing in-service programs.
• Conduct audits on claims and correspondence.
• Maintain and prepare reports on quality audit results.
• Respond to clinical customer complaints/appeals.

Skills

Clinical nursing experience

Audit experience

Proficiency in MS Office

Familiarity with audit methodologies

Education

Bachelor's degree

Valid RN Licensure of NJ

Job description

A national healthcare staffing firm is seeking a qualified professional in Trenton, NJ, responsible for the quality review of claims and managing in-service clinical programs. A valid RN License in NJ and a Bachelor's degree are required, along with three years of clinical nursing and audit experience. The successful candidate will perform audits, maintain quality records, and respond to customer complaints, contributing to regulatory compliance and operational effectiveness. Competitive opportunity with a focus on experience and quality.