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Clinical Quality Assurance Nurse Auditor
ExamWorksClinical Quality Assurance Nurse Auditor responsible for reviewing medical reports and ensuring compliance with healthcare standards. Medical expertise required to impact healthcare integrity in a remote role.
Posted 7/25/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $34 - $35 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical accuracy and presentation of medical reports, with a strong foundation in medical terminology and treatment protocols. Possesses a Registered Nurse (RN) license and the ability to collaborate effectively with healthcare professionals while ensuring compliance with ERISA regulations and client specifications.
Highest-signal resume keywords
Active Registered Nurse (RN) LicenseClinical JudgmentMedical TerminologyExperience in Insurance IndustryKnowledge of ERISA Regulations
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Clinical AccuracyMedical Report ReviewCitation VerificationTreatment ProtocolsProvider Bill Review
Soft Skills
CollaborationStrategic InsightProblem Solving
Certifications & Qualifications
Registered Nurse (RN) License
Industry Keywords
ERISA RegulationsMedical SpecialtiesClinical DeterminationQuality AssuranceHealthcare Compliance
About the role
Key responsibilities & impact- Review and refine critical medical reports, chronologies, and provider bills to ensure flawless clinical accuracy and professional presentation.
- Verify that every clinical determination is backed by robust, current citations from reputable medical journals.
- Collaborate directly with reviewing physicians to clarify complex case details and resolve inconsistencies.
- Ensure full alignment with federal ERISA regulations, state mandates, and client specifications, while strictly verifying that no conflicts of interest exist.
- Help resolve client quality questions, recover missing medical data, and provide management with strategic insights on consultant performance.
Requirements
What you’ll need- Active Registered Nurse (RN) license with strong clinical judgment
- Bachelor/Associate degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience
- Experience with medical terminology, medications, medical specialties and treatment protocols required
- Experience in the insurance industry preferred
Benefits
Comp & perks- Health insurance
- Professional development opportunities