Medical Review Nurse - SNF/MDS Auditor

About the Role:

• Primarily perform Skilled Nursing Facility (SNF) medical claims audit reviews.
• Work remotely in a fast-paced, dynamic environment as part of a multi-location team.
• Join a team of experienced medical auditors performing retrospective and prepayment audits.

Key Responsibilities:

• Audit claims for medically appropriate services in SNF settings using medical review guidelines.
• Document findings, generate letters, and support audits during the appeals process.
• Collaborate with the team and clients to improve policies, provider education, and system edits.

Qualifications:

• Active unrestricted RN license in good standing with no OIG sanctions.
• Minimum five years diversified nursing experience with direct patient care.
• One or more years of MDS/RAI process experience and medical records review.