Internal Audit – Nurse Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute audit projects and consulting assignments in accordance with established methodologies while adhering to budgeted timelines.

• Act as the clinical subject matter expert for CenterWell, Care Management, Utilization Management, and various healthcare delivery services.

• Collaborate with audit professionals throughout the stages of audit planning, testing, and reporting.

• Assess key processes, controls, and adherence to regulatory, contractual, and organizational standards.

• Analyze clinical documentation, operational workflows, and quality management initiatives.

• Identify potential risks and assess the effectiveness of controls.

• Suggest process enhancements that improve compliance, quality, and operational efficiency.

• Present audit and consulting findings through written reports and oral presentations to management.

⛳️ Requirements

• Current, unrestricted RN license.

• A minimum of three (3) years of clinical nursing experience.

• Proven expertise in care management, utilization management, population health, or healthcare operations.

• Experience in assessing clinical processes, internal controls, compliance programs, clinical documentation, healthcare operations, and workflow efficiency.

• Familiarity with healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC, or state and federal guidelines.

• Competence in Microsoft Office Suite, including Word, Excel, and PowerPoint.

• Excellent written and verbal communication abilities.

• Capability to create clear, concise reports and work collaboratively with stakeholders.

• Preferred: Credentials in Case Management (CCM), Utilization Management (CPUM), Internal Auditing (CIA), or a related field.

• Preferred: Experience in managed care or healthcare administration.

• Preferred: Background in audits, assessments, quality reviews, or compliance monitoring activities.

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps.

• A dedicated workspace free from interruptions to ensure the protection of member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive program based on both company and individual performance.

• Comprehensive medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal leave.

• Paid parental and caregiver leave.

• Short-term and long-term disability insurance.

• Life insurance coverage.

• Flexible work-from-home arrangement.

• Opportunities for team engagement meetings and training sessions.