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New York Licensed Clinical Auditor
A company is looking for a Clinical Auditor: Appeals and Grievances. Key Responsibilities Conduct quality audits of appeals and grievances, ensuring compliance with regulatory standards Review and investigate appeals and grievances requests for proper classification and resolution Track audit results and provide feedback to enhance departmental performance and compliance Required Qualifications LPN or RN license 1+ years of experience in Appeals and Grievances High School Diploma or GED from an accredited institution Experience with managed care plan products and knowledge of relevant regulations Familiarity with systems such as TruCare, PEGA, and Microsoft Office applications
A company is looking for a Clinical Auditor: Appeals and Grievances.
Key Responsibilities
Conduct quality audits of appeals and grievances, ensuring compliance with regulatory standards
Review and investigate appeals and grievances requests for proper classification and resolution
Track audit results and provide feedback to enhance departmental performance and compliance
Required Qualifications
LPN or RN license
1+ years of experience in Appeals and Grievances
High School Diploma or GED from an accredited institution
Experience with managed care plan products and knowledge of relevant regulations
Familiarity with systems such as TruCare, PEGA, and Microsoft Office applications