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HEDIS RN - Quality Auditor

Newark, NJ · On-site

$40 - $42/hr

The HEDIS Nurse Auditor is responsible for conducting quality audits related to state audits, HEDIS measures, and quality-related complaints and referrals. * This role also supports data analysis and ...

Varite

HEDIS RN - Quality Auditor

Newark, NJ · On-site

The HEDIS Nurse Auditor is responsible for conducting quality audits related to state audits, HEDIS measures, and quality-related complaints and referrals. * This role also supports data analysis and ...

ProKatchers LLC

RN Auditor

Camarillo, CA · On-site

Qualifications SKILLS & ABILITIES Business, Health Sciences, Managed Care Registered Nurse (RN).Required Experience: 3 plus years of experience in an audit, compliance or delegation oversight role ...

ProKatchers LLC

RN Auditor

Camarillo, CA · On-site

Qualifications SKILLS & ABILITIES Business, Health Sciences, Managed Care Registered Nurse (RN).Required Experience: 3 plus years of experience in an audit, compliance or delegation oversight role ...

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Nursing Auditor information

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How much do nursing auditor jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for nursing auditor in the United States is $32.99, according to ZipRecruiter salary data. Most workers in this role earn between $28.85 and $36.06 per hour, depending on experience, location, and employer.

What is a nursing auditor?

Nursing Auditors are registered nurses who specialize in reviewing healthcare records, processes, and billing to ensure accuracy, compliance, and quality of care. They assess patient charts, evaluate documentation, and verify that medical services meet regulatory standards and insurance guidelines. Nursing Auditors play a critical role in preventing fraud, reducing errors, and optimizing healthcare operations. Their work helps healthcare organizations maintain compliance with legal and ethical standards, ultimately improving patient outcomes.

What is the difference between Nursing Auditor vs Medical Coder?

AspectNursing AuditorMedical Coder
CredentialsRN license, auditing certificationsCertification in coding (CPC, CCS)
Work EnvironmentHospitals, clinics, insurance companiesMedical offices, billing companies, hospitals
Primary ResponsibilitiesReviewing medical records for compliance and accuracyTranslating medical diagnoses and procedures into codes

Both Nursing Auditors and Medical Coders work in healthcare settings, focusing on documentation and compliance. Nursing Auditors primarily review medical records for billing accuracy and regulatory adherence, often requiring nursing licenses. Medical Coders translate clinical information into standardized codes for billing and reporting. While their roles overlap in documentation review, their certifications, skills, and daily tasks differ significantly.

What are some common challenges nursing auditors face when reviewing clinical documentation?

Nursing Auditors often encounter challenges such as incomplete or inconsistent patient records, varying documentation practices across departments, and navigating complex regulatory requirements. Ensuring the accuracy and compliance of records while maintaining positive relationships with clinical staff can also be demanding. Staying current with evolving healthcare standards and effectively communicating audit findings are crucial to success in this role.

How to become a nursing auditor?

To become a nursing auditor, candidates typically need a registered nurse (RN) license and experience in healthcare or medical records. Additional certifications such as the Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) can enhance job prospects. Strong attention to detail, knowledge of healthcare regulations, and proficiency with medical coding and billing are also important.

What are the key skills and qualifications needed to thrive as a nursing auditor, and why are they important?

To thrive as a Nursing Auditor, you need a solid nursing background (often an RN license), strong analytical abilities, and knowledge of healthcare regulations and compliance standards. Familiarity with electronic health records (EHRs), auditing software, and industry certifications like Certified Professional Medical Auditor (CPMA) is commonly required. Attention to detail, integrity, and effective communication are essential soft skills for reviewing records and reporting findings. These skills ensure accurate audits, regulatory compliance, and improved patient care quality within healthcare organizations.
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Nursing Auditor jobs near you
Infographic showing various Nursing Auditor job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 56% Full Time, 17% Part Time, and 23% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $68,617 per year, or $33 per hour.

Remote Auditor, Healthcare Services (RN) - Residency in TX Required

Molina Healthcare

Long Beach, CA • Remote

$29.05 - $56.64/hr

Full-time

Posted 7 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 198 frontline employees who took The Breakroom Quiz

163rd of 304 rated insurance

Job description

JOB DESCRIPTION 

Summary of highly qualified candidates:

  • Must reside in TX and have an active TX RN license in good standing.
  • Focus of these audits is on the functions of the Utilization Department.
  •  Experience in UM with clinical reviews and knowledge of MCG Clinical Criteria is required.
  • Experience with NCQA, EQRO, and HHS ACUR audits, case file preparation and presentation is strongly preferred.

Job Summary

Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. 

Essential Job Duties


Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed. 
Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met. 
Assesses clinical staff regarding appropriate clinical decision-making. 
Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership. 
Ensures auditing approaches follow a Molina standard in approach and tool use. 
Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications. 
Adheres to departmental standards, policies and protocols. 
Maintains detailed records of auditing results. 
Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results. 
Meets minimum production standards related to clinical auditing. 
May conduct staff trainings as needed.  Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct. 

Required Qualifications


At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Strong attention to detail and organizational skills. 
Strong analytical and problem-solving skills. 
Ability to work in a cross-functional, professional environment. 
Ability to work on a team and independently. 
Excellent verbal and written communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 

Preferred Qualifications


Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $29.05 - $56.64 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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