RN or LPN, Medicare Clinical Auditor - Miami, FL - (Miami, FL)

Role: Clinical Auditor, RN or LPN Assignment: Medicare Health Services Location: Miami, FL The hours of this role can be flexible and may be 8am-5pm or 10am-7pm depending on the timing for tasks to be completed. This is an in office role with eligibility to work at home after six months. Assignment Capsule Humana is seeking a Clinical Auditor to ensure the quality and accuracy of work being performed in the HSO Pre-Cert Department. Audit Health Services Department authorizations for appropriateness and provide reporting to support audit findings. Assist department with clinical understanding as it pertains to each audit. Coordinate and conduct organization determination audits and summarize findings for the leadership team to initiate and identify needed corrective action plans. Analyze authorizations and medical records in accordance with specified departmental policies and procedures.