Clinical Auditor/Analyst (RN) - Fraud, Waste & Abuse - (Philadelphia, PA)

Description Are you an experienced nurse looking for an exciting opportunity to work in Fraud and Abuse? Do you have a thorough knowledge of coding and auditing? We are looking for you UPMC Health Plan is hiring a full time Clinical Auditor/Analyst to support our Fraud, Waste & Abuse department for our location in Philadelphia, PA. This position will work daylight hours, Monday through Friday. The Clinical Auditor/Analyst is an integral part of the Fraud, Waste & Abuse group, and is responsible for conducting clinical audits and reviews regarding the analysis of care and services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization. The Clinical Auditor/Analyst creates, maintains and analyzes auditing reports related to their assigned work plan and communicates the results with management.