Nurse Auditor - PACE
Orchard LLC

Job Info

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Nurse Auditor - PACE
(RN Required)
Work from Home within the Continental United States

@Orchard LLC is supporting a not-for-profit corporation that partners with public and private sectors to create high-quality, safe, and efficient delivery of health care and human services programs. Our client has multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our client is also a national leader in fighting fraud, waste, and abuse for large organizations across the country. In addition, our client operates a foundation providing grant opportunities to those with programs for under-served communities.

Our client is seeking an experienced Nurse Auditor to support the Medicare Advantage and Prescription Drug Plan, and Programs of All-Inclusive Care for the Elderly (PACE) Audits conducted by the Centers for Medicare and Medicaid Services (CMS). The positions primary responsibility will be to support the Programs of All-Inclusive Care for the Elderly (PACE) audits.

Essential Duties and Responsibilities include some or all of the following.

• Completes audits to meet applicable contract requirements

• Support Audit Engagement Notice and Universe Selection, Audit Field Work, and Audit Reporting Phases of the process.
• Effectively identifies and resolves issues and determines root cause.
• Interacts with health plans to obtain additional case specific information, as needed.
• Has basic understanding of the use of the computer for entry and research.
• Responsible for case specific or plan specific data entry and reporting.
• Participates in internal and external focus groups and other projects, as required.
• Identifies opportunities to improve processes and procedures.
• Has the responsibility and authority to perform their job and provide customer satisfaction.
• May participate as an audit/investigation team member for both desk and field audits
• Has developed expertise with standard concepts, practice and procedures in field. Relies on limited experience and judgment to plan and accomplish goals.
• Performs a variety of tasks some requiring independent thought and research. A degree of creativity and latitude is required.

Your background will include:
Education and/or Experience

• BSN OR an RN with additional current and active degree/license/certification/s in a relevant healthcare discipline (i.e., CPC, CPHM, CFE, CCM, HCAFA).
• Must possess at least five (5) years experience.
• At least one year healthcare experience that demonstrates expertise in conducting utilization reviews or audits
• ICD-9 coding, CPT coding, and knowledge of Medicare Part C regulations and/or PACE plans strongly preferred.

Certificates, Licenses, Registrations

• Current, active and non-restricted RN licensure required.

If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you!

Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atOrchard.com.

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