Clinical Nurse Auditor

Clinical Nurse AuditorCGI is a global IT and business consulting services firm that helps clients achieve meaningful outcomes through technology, industry expertise, and innovative solutions. With a strong global presence and a collaborative, people-first culture, CGI empowers professionals to make a lasting impact for clients and the communities we serve. We are seeking an experienced Clinical Nurse Auditor to join our CGI CSG Clinical Audit Team. In this role, you will leverage your clinical expertise and critical thinking skills to review medical records, assess the medical necessity and appropriateness of healthcare services, and identify potential improper payments on behalf of commercial and government healthcare clients. You will conduct independent, evidence-based clinical reviews across inpatient, outpatient, and other care settings, ensuring that audit decisions are accurate, thoroughly documented, and aligned with client requirements, regulatory standards, and established clinical guidelines. As a member of our collaborative Clinical Audit Team, you will receive comprehensive training, ongoing clinical education, and quality management support to strengthen your auditing expertise. You will work closely with Clinical Audit Team Leaders, Physician Advisors, and other clinical professionals to support audit accuracy, consistency, and continuous improvement. This position is fully remote and can be performed from anywhere in the United States. Candidates must be available to work Eastern Time Zone hours. Travel of up to 25% may be required for training and onsite audit activities. Your future duties and responsibilities include: Conduct comprehensive inpatient and outpatient clinical audits to evaluate medical necessity, reasonable and necessary services, prior authorization compliance, clinical validation, and medical service charges Analyze medical records, clinical documentation, and supporting provider information to identify potential improper payments and determine whether billed services meet applicable clinical and regulatory requirements Apply established clinical screening criteria, evidence-based guidelines, client-specific requirements, and applicable regulations to deliver independent, accurate, and well-supported audit decisions Develop clear, concise, and clinically sound audit rationales, documenting findings and supporting evidence in ProperPay in accordance with established procedures and client expectations Collaborate with the DRG Validation Team to identify and document relevant coding and clinical validation issues, ensuring alignment between medical documentation and billed services Escalate complex clinical cases to Physician Advisors when required, following established referral procedures and contractual guidelines Maintain high standards of audit quality, accuracy, and productivity while meeting established performance metrics, turnaround times, and documentation requirements Participate in ongoing clinical education, inter-rater reliability assessments, quality reviews, and performance improvement initiatives to promote consistency and excellence in clinical auditing Partner with Clinical Audit Team Leaders to address audit challenges, communicate operational needs, and adapt to evolving client requirements and business priorities Required qualifications to be successful in this role include: Active, unrestricted Registered Nurse (RN) license issued by the applicable Board of Nursing or licensing authority in your state of residence Minimum of 5 years of direct clinical nursing experience in an Intensive Care Unit (ICU) or Critical Care Unit (CCU) setting Strong clinical assessment, critical thinking, and analytical skills with the ability to evaluate complex medical records and make independent, evidence-based determinations Solid understanding of acute care clinical practices, disease processes, treatment protocols, and healthcare documentation standards Excellent written communication skills, including the ability to develop clear, well-reasoned clinical narratives with accurate grammar, spelling, punctuation, and supporting rationale Proficiency with Microsoft Office applications, including Outlook, Word, and Excel, as well as Windows-based operating systems and electronic documentation tools Strong organizational and time management skills with the ability to manage multiple audit assignments, adapt to changing priorities, and consistently meet deadlines Ability to work independently in a remote environment while maintaining effective communication, accountability, and collaboration with clinical and operational teams Availability to work Eastern Time Zone hours and willingness to travel up to 25% as needed for training, onsite reviews, or other business requirements What you can expect from us: Together, as owners, let's turn meaningful insights into action. Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you'll reach your full potential because You are invited to be an owner from day 1 as we work together to bring our Dream to life. That's why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company's strategy and direction. Your work creates value. You'll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise. You'll shape your career by joining a company built to grow and last. You'll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.