1. Perform nurse auditing, utilization review, and bill review activities in accordance with established clinical guidelines and procedures.

2. Review medical records and clinical documentation to assess the appropriateness of healthcare services and billing.

3. Apply clinical knowledge and judgment when reviewing complex medical cases and supporting documentation.

4. Maintain accurate review records and ensure compliance with quality standards and operational requirements.

5. Collaborate with relevant healthcare and operations teams to resolve review-related issues and support timely case processing.

Required Skills : 

1. Active US Registered Nurse (USRN) license from a mainland US state.

2. At least 2 years of recent surgical experience in a hospital setting, or relevant clinical case management experience.

3. At least 2 years of experience in nurse auditing, utilization review, and bill review.

4. Strong clinical assessment, medical documentation review, and analytical skills.

5. Good communication, attention to detail, and ability to work in a shifting schedule.

Qualifications : 

• Must hold an active USRN license from any mainland US state.

• Must have at least 2 years of recent surgical experience in a hospital setting; alternatively, 2+ years of clinical case management experience involving complex medical, legal, and consult review is preferred.

• Must have at least 2 years of experience applying nurse auditing, utilization review, and bill review in daily operations.

• Must be willing to attend onsite training and transition to a hybrid or temporary WFH arrangement afterward.

• Must be amenable to a shifting schedule.