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RN Utilization Review Medical Auditor
JOB SUMMARYThis RN position primarily serves in the capacity of auditing and reviewing the "Appeals and Grievances" that our Scott and White Health Plans receive from a variety of sources.  While also referred to as the "Medical Nurse Auditor" from within our organization, the role is also expected to perform clinical reviews and provide input to our policies / procedures for our Medical Audit programs (associated with denials, appeals, grievances), insuring that our review and medical audit procedures are maintained, adhered to, and are compliant with state and national regulations.ESSENTIAL FUNCTIONS OF THE ROLEDevelops a multi-faceted audit plans, including for Diagnosis-Related Gro


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