ZipRecruiter

Log In

1

Nursing Auditor Jobs (NOW HIRING)

Molina Healthcare

Auditor, Clinical Services

Miami, FL · On-site

$29.05 - $56.64/hr

Registered Nurse (RN). License must be active and restricted in state of practice. Strong attention ... auditing experience. #PJCorp #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Miami, FL

$29.05 - $56.64/hr

Registered Nurse (RN). License must be active and restricted in state of practice. Strong attention ... auditing experience. #PJCorp3 #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Tampa, FL

$29.05 - $56.64/hr

Registered Nurse (RN). License must be active and restricted in state of practice. Strong attention ... auditing experience. #PJCorp3 #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Tampa, FL · On-site

$29.05 - $56.64/hr

Registered Nurse (RN). License must be active and restricted in state of practice. Strong attention ... auditing experience. #PJCorp #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Long Beach, CA · On-site

$29.05 - $56.64/hr

Registered Nurse (RN). License must be active and restricted in state of practice. Strong attention ... auditing experience. #PJCorp #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Orlando, FL

$29.05 - $56.64/hr

Registered Nurse (RN). License must be active and restricted in state of practice. Strong attention ... auditing experience. #PJCorp3 #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Orlando, FL · On-site

$29.05 - $56.64/hr

Registered Nurse (RN). License must be active and restricted in state of practice. Strong attention ... auditing experience. #PJCorp #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Miami, FL · On-site

$29.05 - $56.64/hr

... Nurse (RN). License must be active and restricted in state of practice. • Strong attention to ... auditing experience. #PJCorp3 #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Miami, FL

$29.05 - $56.64/hr

... Nurse (RN). License must be active and restricted in state of practice. • Strong attention to ... auditing experience. #PJCorp3 #LI-AC1 To all current Molina employees: If you are interested in ...

Molina Healthcare

Auditor, Clinical Services

Tampa, FL · On-site

$29.05 - $56.64/hr

... Nurse (RN). License must be active and restricted in state of practice. • Strong attention to ... auditing experience. #PJCorp3 #LI-AC1 To all current Molina employees: If you are interested in ...

previous page

Showing results 41-60

All JobsNursing Auditor Jobs

Nursing Auditor information

See salary details

$19

$32

$46

How much do nursing auditor jobs pay per hour?

As of Aug 10, 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.
More about Nursing Auditor jobs
What cities are hiring for Nursing Auditor jobs? Cities with the most Nursing Auditor job openings:
What states have the most Nursing Auditor jobs? States with the most job openings for Nursing Auditor jobs include:
What job categories do people searching Nursing Auditor jobs look for? The top searched job categories for Nursing Auditor jobs are:
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, 57% Full Time, 17% Part Time, and 22% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $68,617 per year, or $33 per hour.

High-Cost Claimant Review Unit Nurse Auditor (Remote in AZ)

Blue Cross Blue Shield of Arizona

Phoenix, AZ • On-site, Remote

Full-time

Re-posted 24 days ago

Blue Cross Blue Shield Of Arizona rating

5.9

Company rating: 5.9 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

286th of 304 rated insurance

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
  • Onsite: daily onsite requirement based on the essential functions of the job
  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is remote within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
This position is responsible for assessment and documentation of member utilization and prediction of future spend feeding internal and external customer reporting. Primary responsibilities include:
  • Function as a designated clinical resource to review High Cost Claimants to identify opportunities to improve member outcomes and determine correct utilization of resources
  • Collaborate with multi-disciplinary teams to determine if there are other resources, BCBSAZ programs, or community resources that can curtail benefit spend or improve outcomes
  • Focus on enhancing customer relationship and service as the primary clinical point of contact

REQUIRED QUALIFICATIONS
Required Work Experience
  • 5 years of experience working within a healthcare and/or management care
  • 2 consecutive years' experience as an RN analyst or auditor in Utilization Review, Medical Claim Review and/or Care Management

Required Education
  • Associate's Degree in Nursing or related field of study

Required Licenses
  • Active, unrestricted license to practice as a registered nurse (RN) in the state of Arizona (a state in the united states)

Required Certifications
  • N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience
  • 7 years' experience working within a healthcare and/or management care.
  • 3 years' experience with managing direct customer facing or account management experience
  • Experience in working in more than one of Utilization Management, Medical Claim Review and Care Management
  • Experience with working with VITAL, Metavance and/or Guiding Care platforms
  • Experience in operational analysis, data analysis and problem resolution types of activities

Preferred Education
  • Bachelor's or Master's Degree in Nursing or related field of study

Preferred Licenses
  • N/A

Preferred Certifications
  • Certified Commission of Case Managers
  • PMP Certification or Six Sigma/Lean Project Management
  • Certified Professional in Healthcare Quality (CPHQ)

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
  • Analyze utilization data from provided sources to evaluate cost drivers.
  • Apply clinical knowledge, incorporating the persistency score to determine if member care needs will be ongoing versus an acute episodic.
  • Apply knowledge of customer benefit structure to determine appropriate use of services.
  • Collaborate with multi-disciplinary team to determine if there are other resources; BCBSAZ programs, community resources that can curtail benefit spend or improve outcomes.
  • Document findings in a manner that can be consumed by internal process for reporting purposes, internal and external customers.
  • Refer the member to appropriate internal BCBSAZ group to manage and coordinate care as indicated.
  • Continue to evaluate the member's benefit spend according to Key Decision Criteria.
  • Responsible for the professional, efficient and timely delivery of services to members and customer/Group Benefit Administrator requesting assistance. This includes but is not limited to providing information and assistance with information related to members' claims and clinical course, expected outcomes and persistence of claim expenses.
  • Provide proactive clinical recommendations, information regarding trends, program and industry changes the customer and member experience.
  • Represent customer-internally and coordinate with other departments such as medical and pharmacy account team to address ongoing needs, implement care initiatives, projects and customer systems.
  • Lead process improvement initiative and projects to improve the delivery of services.
  • Lead efforts to identify best practices and resources required to support customer with meeting business commitments and enhance member experience.
  • Develop relationships and establish credibility with key stakeholders (internal and external) to achieve solution strategies and objectives. Routinely collaborate with account management team to provide clinical aspects of High Cost Claimant reviews.
  • Able to analyze and interpret benefit designs and identify opportunities to increase efficiency.
  • Complete High Cost Claimant screening and analysis to identify trends and opportunities; present findings to key stakeholders and clinical leadership.
  • Support clinical quality audit activities under the direction of manager to identify opportunities to deliver on commitments and enhance customer satisfaction/experience.

LEADERSHIP
  • Maintain effective working relationships to ensure teamwork in achieving company goals.
  • Foster effective communication with business partners by setting clear directives and providing exchange of ideas.
  • Provide leadership on change management principles to ensure maximize benefit and alleviate unnecessary disruption.
  • Effectively communicates analytical and reporting needs to supporting departments. Identify and create opportunities to manage trend(s).

ADMINISTRATIVE
  • Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
  • Establish performance goals in accordance with overall BCBSAZ objectives and divisional strategic planning.
  • Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve

Business goals/objectives.
  • Ensure the existence of documented policies and procedures.
  • Coordinate activities between multiple divisions to achieve desired results.
  • Volunteer within the community to help BCBSAZ give back to community charitable efforts.
  • Ability to travel up to 25% of time to attend work related customer, business meetings, trainings and conferences.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform other duties as assigned.

Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

What Blue Cross Blue Shield Of Arizona employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply