Top 1455 Rn Registered Nurse I Jobs

Clinical Auditor I-Nurse
WellSense Health Plan —Remote
- $64,000 - $93,000 a year
- Full-time
- Nursing
- RN License
- Bachelor's degree
- Health insurance
- Dental insurance
Registered Nurse Float Pool I Full Time Days
Hollywood Presbyterian —Los Angeles, CA
- $51.30 - $81.85 an hour
- Full-time
- Nursing
- Float pool
- RN License
Quick Apply
Registered Nurse 1 Psychiatric (NY HELPS), Part-Time, New York City Children's Center, Queens Campus, P27407
State of New York - Mental Health, Office of —Queens, NY
- $115,147 - $124,138 a year
- Part-time
- Background check
- Nursing
- Psychiatry
- Paid holidays
- Health insurance
Registered Nurse (RN) 1
Legacy Concierge —Pasadena, CA
- $55 - $68 an hour
- Part-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Health insurance
Quick Apply
Registered Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, P26909
State of New York - Mental Health, Office of —New York, NY
- $115,147 - $124,138 a year
- Full-time
- Background check
- Nursing
- Psychiatry
- Paid holidays
- Health insurance
Second Level Reviewer I PRN Remote
AdventHealth Corporate —Altamonte Springs, FL
- $31.82 - $59.17 an hour
- PRN
- Remote
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
1:1 RN Registered School Nurse
White Glove Community Care —Bronx, NY
- Up to $2,600 a week
- Nursing
- RN License
- 1 year
- Flexible schedule
Registered Nurse I
International Community Health Services —Seattle, WA
- $43.78 - $64.10 an hour
- On call
- Nursing
- RN License
- BLS Certification
- Paid holidays
- Dental insurance
Quick Apply
Registered Nurse II (RN), MedSurg/Tele - One UMMS Staffing Center
University of Maryland Medical System —Baltimore, MD
- $55 an hour
- PRN
- Nursing
- Surgery
- RN License
REGISTERED NURSE I, SHERIFF
Los Angeles County Department of Human Resources —Los Angeles County, CA
- $96,316.32 - $144,173.04 a year
- Weekends as needed
- Addiction Medicine
- RN License
- BLS Certification
RN Registered Nurse ICU Tier 1 PRN Days 6:45a-7:15p at FCCC
Temple University Health System —Philadelphia, PA
- Per diem
- Nursing
- RN License
- BLS Certification
RN Staff Nurse I - Plastic Surgery
Washington University in St Louis —St. Louis, MO
- $60,000 - $99,900 a year
- Online Application
- Nursing
- Surgery
- Patient monitoring
- Commuter assistance
- Employee assistance program
RN Staff Nurse I - Clinical Translational Research Unit
Washington University in St Louis —St. Louis, MO
- $60,000 - $99,900 a year
- Online Application
- Nursing
- Patient monitoring
- RN License
- Commuter assistance
- Employee assistance program
Registered Nurse (RN) M/S 7A Per Diem Level 1 (7a-7p)
Virtua Health —Voorhees, NJ
- $56.17 an hour
- Per diem
- RN License
- Mid-level
- Communication skills
- AD&D insurance
- Disability insurance
12d
Staff RN - Post Partum (1 Tower) - Part Time 12 Hours Days (7:00AM to 7:30PM) (Union, Non-Exempt)
USC —Arcadia, CA
- $49.86 - $76.69 an hour
- 12 hour shift
- Nursing
- RN License
- Hospital
Registered Nurse - B3 Acute Care/C I U
Lakeland Regional Health —Lakeland, FL
- $38.06 - $45.79 an hour
- Rotating weekends
- Acute care
- Nursing
- RN License
Registered Nurse 1 Psychiatric (NY HELPS), Western New York Children's Psychiatric Center, P27264
State of New York - Mental Health, Office of —Buffalo, NY
- $96,147 - $105,138 a year
- Full-time
- Background check
- Nursing
- Psychiatry
- Paid holidays
- Health insurance
Registered Nurse (RN) JRI Med Surg 4 - Per Diem level 1 (7a-7p)
Virtua Health —Voorhees, NJ
- $56.17 an hour
- 12 hour shift
- Nursing
- RN License
- Hospital
- AD&D insurance
- Disability insurance
12d
County Jail Registered Nurse (RN)-1
Ancestor Health —Lowville, NY
- $59 an hour
- Weekends as needed
- CPR Certification
- Nursing
- RN License
Registered Nurse I SE
Atrium Health —Charlotte, NC
- $34.90 - $52.35 an hour
- Part-time
- Acute care
- Nursing
- Medication administration
- Paid parental leave
- Disability insurance

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Clinical Auditor I-Nurse

WellSense Health Plan -
Remote

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Job Details

Full-time
$64,000 - $93,000 a year

Benefits

Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
403(b)
Opportunities for advancement

Qualifications

Nursing
RN License
Nursing

Full Job Description

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

The Clinical Auditor I performs detailed medical record audit review and analysis of the health plan’s outpatient, professional and ancillary claims to ensure that all reimbursement to the provider is paid accurately and ensuring adherence to regulations, internal policies and best practice of patient care.

Our Investment in You:

Full-time remote work

Competitive salaries

Excellent benefits

Key Functions/Responsibilities:

Analyze patient records, treatment plans, and medical billing documents to ensure accuracy, completeness, and strict compliance with healthcare standards and regulations.

Verify that procedures and diagnoses are accurately coded using appropriate CPT, HCPCS, and ICD-10 codes. Ensure that the coding reflects the clinical documentation accurately and complies with current guidelines.

Check for consistent documentation across patient records, confirming that all entries adhere to regulatory mandates, internal policies, contract stipulations, and benefit coverages.

Identify any documentation or billing discrepancies during the review process. This includes spotting errors, omissions, or inconsistencies that may affect reimbursement or patient care quality, and flagging these issues as needed.

Based on audit findings, regularly update and refine clinical audit guidelines and protocols.

Use statistical and analytical methods to examine clinical data.

Methodically review data to identify discrepancies and irregularities that could indicate non-compliance with internal policies, contractual obligations, or regulatory mandates.

Analyze data trends to determine potential areas of risk that might adversely affect patient care or disrupt the organization’s operations.

Continuously monitor and document recurring patterns or anomalies in clinical data.

Based on the insights gathered, provide well-founded recommendations for new audit projects.

Conduct both scheduled and ad hoc audits in strict accordance with established guidelines and internal processes. This involves planning and executing audit activities to ensure every clinical record is reviewed consistently while aligning with quality assurance benchmarks.

Develop comprehensive audit reports that clearly outline all findings. Reports must detail discrepancies, note any process inefficiencies, and provide precise, actionable recommendations for improvement.

Play a supportive role in the amendment and appeals process. This includes coordinating with providers to resolve discrepancies and ensuring the audit conclusions are fully and fairly reviewed.

Finalize all audits by ensuring that all findings are documented, follow-up actions are clearly communicated, and the entire process meets the established timelines and productivity standards for the role.

Collaborate closely with clinical staff, audit coordinator, and other members of the audit team on audit findings and questions.

Maintain active communication with providers by preparing precise documentation, responding promptly to emails and phone calls, and offering detailed explanations of audit results.

Ensure that any audit denial rationale is clearly, concisely, and accurately communicated.

Continuously monitor evolving federal and state healthcare regulations along with industry standards by engaging in regular education and policy reviews. Ensure that all clinical documentation and audit processes are consistently aligned with current regulatory requirements and best practices.

Evaluate clinical and reimbursement activities to determine payment compliance under WellSense clinical and reimbursement policies.

Proactively identify potential fraud and abuse by scrutinizing clinical data, documenting billing errors, and highlighting opportunities to manage benefit costs and secure savings.

When discrepancies or irregularities signal deeper issues, refer cases to the Special Investigations Unit (SIU) or the Third-Party Liability team.

Detect potential quality of care or utilization issues during audits and promptly report these findings to management.

Assist in educating clinical personnel on documentation requirements and audit practices to enhance compliance and overall patient care quality.

Qualifications:

Bachelor's degree in nursing or an equivalent combination of education, training, and experience is required.

Two years CM, UM, claims auditing or other clinical health insurance role

Two years minimum RN experience in acute care setting

Behavioral Health and/or Inpatient DRG experience required

Certification or Conditions of Employment:

Valid Registered Nurse License required

Coding Certification Preferred - CPC or CCS certification

Basic familiarity with CPT, ICD-10 and HCPCS coding is preferred

Claims processing experience is preferred

Compensation Range

$64,000 - $93,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Apply Now

Refine Your Search

Rn Registered Nurse I jobs

Clinical Auditor I-Nurse

Registered Nurse Float Pool I Full Time Days

Registered Nurse 1 Psychiatric (NY HELPS), Part-Time, New York City Children's Center, Queens Campus, P27407

Registered Nurse (RN) 1

Registered Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, P26909

Second Level Reviewer I PRN Remote

1:1 RN Registered School Nurse

Registered Nurse I

Registered Nurse II (RN), MedSurg/Tele - One UMMS Staffing Center

REGISTERED NURSE I, SHERIFF

RN Registered Nurse ICU Tier 1 PRN Days 6:45a-7:15p at FCCC

RN Staff Nurse I - Plastic Surgery

RN Staff Nurse I - Clinical Translational Research Unit

Registered Nurse (RN) M/S 7A Per Diem Level 1 (7a-7p)

Staff RN - Post Partum (1 Tower) - Part Time 12 Hours Days (7:00AM to 7:30PM) (Union, Non-Exempt)

Registered Nurse - B3 Acute Care/C I U

Registered Nurse 1 Psychiatric (NY HELPS), Western New York Children's Psychiatric Center, P27264

Registered Nurse (RN) JRI Med Surg 4 - Per Diem level 1 (7a-7p)

County Jail Registered Nurse (RN)-1

Registered Nurse I SE

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