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Registered Nurse Rac Auditor Jobs (NOW HIRING)

CommuniCare Family of Companies

RN MDS Nurse

Cincinnati, OH · On-site

$34.25 - $45/hr

Do you have what it takes to be an RN MDS Nurse with CommuniCare? QUALIFICATIONS & EXPERIENCE ... MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is ...

Communicarehealth

RN MDS Nurse

Greenwood, SC · On-site

$32.75 - $43/hr

Do you have what it takes to be an RN MDS Nurse with CommuniCare? QUALIFICATIONS & EXPERIENCE ... MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is ...

Communicarehealth

RN MDS Coordinator

Oxford, AL

$30 - $36.25/hr

Do you have what it takes to be an RN MDS Nurse with CommuniCare? QUALIFICATIONS & EXPERIENCE ... MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is ...

Communicarehealth

$30.75 - $40.25/hr

Do you have what it takes to be an RN MDS Nurse with CommuniCare? QUALIFICATIONS & EXPERIENCE ... MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is ...

Communicarehealth

RN MDS Coordinator

Addison, IL

$37.25 - $45/hr

Do you have what it takes to be an RN MDS Nurse with CommuniCare? QUALIFICATIONS & EXPERIENCE ... MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is ...

Communicarehealth

$30.75 - $40.25/hr

Do you have what it takes to be an RN MDS Nurse with CommuniCare? QUALIFICATIONS & EXPERIENCE ... MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is ...

Morris Hospital

MANAGER CASE MANAGEMENT

Morris, IL · On-site

$93K - $140K/yr

Current IL RN Licensure. * Bachelor's Degree in Nursing required, Master's degree preferred with ... Experience in RAC auditing / review. * DCFS Mandated Reporter Certificate of Completion required.

Morris Hospital

MANAGER CASE MANAGEMENT

Morris, IL

$19.50 - $25/hr

Current IL RN Licensure. * Bachelor's Degree in Nursing required, Master's degree preferred with ... Experience in RAC auditing / review. * DCFS Mandated Reporter Certificate of Completion required.

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Registered Nurse Rac Auditor information

What is the difference between Registered Nurse Rac Auditor vs Registered Nurse Case Manager?

AspectRegistered Nurse Rac AuditorRegistered Nurse Case Manager
CertificationsRN license, RAC certification preferredRN license, case management certification often preferred
Work EnvironmentHealthcare facilities, insurance companies, government agenciesHospitals, clinics, insurance companies
Primary FocusReviewing Medicare/Medicaid claims for complianceCoordinating patient care and discharge planning
Industry UsageHealthcare reimbursement and compliancePatient care coordination and management

While both roles require an RN license, Registered Nurse Rac Auditors focus on reviewing claims for Medicare and Medicaid compliance, whereas Registered Nurse Case Managers coordinate patient care and discharge planning. The roles differ mainly in their primary responsibilities and work settings, but both are vital in healthcare operations.

What kind of nurses make 6 figures?

Registered Nurse Rac Auditor roles typically do not reach six-figure salaries, but advanced nursing positions such as Nurse Anesthetists, Nurse Practitioners, and Nurse Managers often do. These roles usually require additional certifications, specialized skills, and experience, and they tend to offer higher compensation within the nursing field.
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Registered Nurse Rac Auditor jobs near you

RN Auditor - FT Days

Torrance Memorial Medical Center

Torrance, CA • On-site

$48.77 - $81.51/hr

Full-time

Posted 19 days ago

Torrance Memorial Medical Center rating

8.5

Company rating: 8.5 out of 10

Based on 39 frontline employees who took The Breakroom Quiz

46th of 994 rated hospitals

Job description

Description
Under direct supervision of the Manager, RN Auditor, the RN Auditor is responsible for the review of medical record documentation for accuracy, and completeness in regard to compliance with all Federal and State regulatory bodies, Medicare, and Medi-Cal programs by analyzing ADT documentation, Business Office notes and Case Management clinical reviews through intensive medical record review.Core Competencies
  • Ensures other requirements from a regulatory perspective such as delivery of the "Medicare Important Message" are met.
  • Ensures all other clinical documents meet regulatory requirements as it relates to date, time and signature.
  • Performs concurrent and retrospective review of Medicare and MediCal and other payors patient's electronic and paper charts for correct patient status and appropriate admissions transfer and discharge physician orders.
  • Verifies billing system for correct status prior to bill being approved and submission of daily adjudication reports.
  • Applies appropriate clinical criteria (i.e. MCG) when reviewing medical records either concurrently or retrospectively.
  • Works collaboratively with other hospital departments regarding ongoing employee education for correct data entry of ADT orders within the Medical Center.
  • Understands the responsibilities of the Physician Advisors as the first and second level professional review organization within the Medical Center.
  • Acts as a change agent by recognizing patterns and identifying opportunities for interdepartmental process improvement.
  • Identifies and refers accounts meeting established criteria to the Utilization Review Committee.
  • Documents audit finding such as: correct account status; level of care changes; etc., if applicable, on the Billing Audit form.
  • Assists with RAC preparation.
  • Assists in gathering documentation necessary to respond to the initial data requests and any subsequent appeals.
  • Participates in department and hospital Performance Improvement (PI) activities.

Education
DegreeProgramAssociatesNursing
Experience
Number of Years ExperienceType of Experience5Case Management and/or Utilization Management experience.
Additional InformationRequires a working knowledge of CMS guidelines and related healthcare industry standards. Must have clinical documentation, medical necessity and/or utilization management review experience.
License / Certification Requirements
Registered Nurse LicenseANCC Certification within a year of hire
Compensation Range
$48.77 - $81.51 / Hour

What Torrance Memorial Medical Center employees say

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Hours and flexibility

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