State Licensed Clinical Audit Specialist

State Licensed Clinical Audit Specialist, responsible for conducting full-time retrospective and focused audits of medical necessity determinations to ensure accuracy and compliance with regulations. Key Responsibilities Conduct retrospective and targeted audits of utilization management medical necessity determinations Analyze audit findings to identify trends and provide recommendations for process improvement Collaborate with internal stakeholders to support compliance with regulatory standards and organizational goals Required Qualifications, Training, and Education Associates of Science (A.S) in Nursing (ASN) required; Bachelor of Science (B.S) in Nursing (BSN) preferred Five (5) years of clinical or related healthcare industry experience required Two (2) years of Utilization Management/Utilization Review experience required Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required MCG Certification(s) required or must be obtained within six (6) months of hire