CGI is one of the world's largest independent IT and business consulting services firms. We partner with commercial and government clients to deliver innovative technology and business solutions that improve outcomes for millions of people. At CGI, you'll join a collaborative, client-focused organization where your expertise helps deliver meaningful impact while supporting continuous learning and professional growth.
CGI is seeking a Clinical Nurse Auditor to join our Clinical Services Group (CSG) Clinical Audit Team. In this role, you will conduct comprehensive clinical audits of medical records to determine the medical appropriateness and necessity of healthcare services provided to members of commercial and government health plans. Your expertise will support the identification of improper payments while ensuring audit decisions are objective, well-supported, and aligned with applicable clinical guidelines, regulatory requirements, and client-specific policies.
As a Clinical Nurse Auditor, you will leverage your critical thinking, clinical expertise, and strong documentation skills to review inpatient and outpatient claims, evaluate medical necessity, validate clinical services, and prepare detailed audit determinations. You will receive comprehensive training on CGI's audit methodologies, documentation standards, and proprietary tools while participating in ongoing education related to clinical procedures, disease states, regulatory changes, and audit best practices. This position is remote within the United States, and candidates must be available to work Eastern Time Zone business hours.
Conduct inpatient and outpatient clinical audits to evaluate medical necessity, reasonable and necessary services, prior authorization validation, clinical validation, medical service charge audits, and other audit types as required
Review medical records and provider documentation to identify unsupported services and recover improper payments in accordance with client contracts and regulatory guidelines
Develop comprehensive audit rationales supported by clinical documentation, established review criteria, applicable regulations, and internal audit guidelines
Accurately document audit findings and determinations within CGI's audit platforms while maintaining thorough, well-organized case records
Collaborate with Physician Advisors and internal clinical specialists when required to support complex clinical determinations
Support Clinical Validation and DRG validation activities by documenting coding-related findings in partnership with specialized review teams
Maintain departmental productivity, quality, inter-rater reliability, and performance standards while meeting established deadlines
Communicate effectively with leadership regarding workload, scheduling, operational issues, and performance barriers while adhering to CGI corporate policies and compliance requirements
Active, unrestricted Registered Nurse (RN) license in your state of residence
Minimum of 5 years of recent Intensive Care Unit (ICU) or Critical Care Unit (CCU) nursing experience
Strong clinical knowledge with the ability to evaluate complex medical records across multiple healthcare settings
Experience interpreting clinical documentation to support medical necessity and utilization review determinations
Excellent written communication skills with the ability to prepare detailed, well-supported clinical narratives using proper grammar and documentation standards
Strong proficiency with Microsoft Office applications including Outlook, Word, and Excel, along with Windows-based operating systems
Ability to work independently, manage multiple priorities, and consistently meet productivity and quality expectations
Strong critical thinking, analytical, and decision-making skills with exceptional attention to detail
Willingness to work Eastern Time Zone hours and travel up to 25% as needed for training or onsite audit activities
Desired qualifications
Previous experience performing medical record audits, utilization review, payment integrity, or clinical claim review
Experience reviewing Commercial and Government healthcare claims
Familiarity with medical necessity criteria, healthcare regulations, and payer audit processes
Experience with clinical documentation improvement (CDI), DRG validation, or payment integrity programs
Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), or other relevant healthcare certifications
Bachelor's degree in Nursing (BSN) or an advanced nursing degree
Other Information:
CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $70,800.00 $123,800.00.
CGI's benefits are offered to eligible professionals on their first day of employment to include:
. Competitive compensation
. Comprehensive insurance options
. Matching contributions through the 401(k) plan and the share purchase plan
. Paid time off for vacation, holidays, and sick time
. Paid parental leave
.Learning opportunities and tuition assistance
. Wellness and Well being programs
- Communication
- MS Office365
Together, as owners, lets turn meaningful insights into action.
Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, youll reach your full potential because
You are invited to be an owner from day 1 as we work together to bring our Dream to life. Thats why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our companys strategy and direction.
Your work creates value. Youll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.
Youll shape your career by joining a company built to grow and last. Youll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.
Come join our teamone of the largest IT and business consulting services firms in the world.
Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business.
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at [email protected]. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.
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All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.
CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGIs legal duty to furnish information.
