Nurse Auditor Jobs
Nurse Auditor jobs are open across health insurance, hospital systems, managed care, and government payers, at levels from staff auditor to director, with specializations in clinical documentation improvement, Medicare/Medicaid compliance, and coding audit. See the openings below and apply to the ones that match your experience.
Find Nurse Auditor JobsLooking for remote work? View remote nurse auditor jobs →Overview
Showing 5 of 11+ Nurse Auditor jobs
Department Name:
PHSO Med Claims ReviewWork Shift:
DayJob Category:
Clinical CareYou have a place in the health care industry. If you’re looking to leverage your abilities to make a real difference – and real change in the health care industry – you belong at Banner Plans & Networks.
Banner Health is proud to be recognized on Forbes list of America’s Dream Employers 2027 for the third consecutive year. This recognition highlights our commitment to supporting team members through comprehensive benefits, opportunities for both personal and professional growth, inclusive and empowering work environments, and resources that promote a healthy work-life balance. Banner Health ranked 56 out of the 500 companies made the list.
This Remote Hybrid position, will work 4x10 hour weekday shifts.
Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY
This position audits the organization's RN Reviews/Case Managers for adherence to established policies and guidelines surrounding case reviews for medical necessity. Uses critical thinking to audit clinical documentation confirming appropriate application of evidence based clinical criteria and proprietary tools and adherence to established productivity requirements. The position requires a sound knowledge of applicable regulations, including Medicare and Medicaid and has an understanding of our large commercial plans. Conducts telephonic audits, ensuring adherence to Banner’s Core Behaviors.
CORE FUNCTIONS
1. Performs audits for inpatient and/or outpatient cases, procedural processes and other potential compliance risk areas. Audits medical records to monitor compliance ensuring adherence to established processes and workflows. Identifies areas of potential risk through audit processes, as well as assists with presentation of audit findings and design and monitoring of necessary corrective action.
2. Researches regulatory and medical necessity requirements and develops audit tools and report forms at the direction of the Care Management leadership.
3. Identifies training opportunities based on audits, designs and presents such education to prevent repeated compliance risks at the direction of the compliance leadership team. Provides compliance/documentation education sessions to Medical Directors of Care Coordination (MDCC) RN Reviewers, Case Managers and other staff.
4. Acts as a knowledge resource to the registration staff as to requirements for compliance with specific regulatory and accreditation requirements for federal, state and third party agencies. Pursues and participates in education to remain current with changes in the healthcare and insurance industries. As assigned, provides training for RN Reviewer/Case Management staff and other staff.
5. Assists the organization's compliance officers, as directed, to research and investigate complaints, concerns or questions relative to compliance issues. Investigates and follows up on reported issues as directed.
6. Maintains awareness of laws and regulations and conducts research as needed to identify applicable laws, regulations and practices to maintain compliance. Reviews related policies and procedures and literature. Communicates applicable medical necessity compliance issues to Care Management leadership and assists in the distribution of training of such changes.
7. Assumes additional responsibilities to assist and support the organization's compliance program often dealing with complex and unique situations and problems.
8. Performs job functions on a system-wide basis. Internal and external customers include, but are not limited to, executives and managers, compliance committees, physicians and clinical staff.
MINIMUM QUALIFICATIONS
Requires knowledge typically gained with completion of a bachelor's degree in nursing or related field.
Registered Nurse (R.N.) licensure in the state of practice.
Requires skills and abilities normally acquired with two to three years of clinical experience and/or five years of experience as an RN Reviewer. Must be able to understand, apply and interpret complex case reviews and be able to work closely with our MDCC’s and others in a variety of settings.
Requires clinical knowledge, critical and analytical thinking skills to conduct compliance audits and draft reports. Computer skills in word processing and spreadsheets required. Ability to organize workload, manages multiple projects, and maintain confidentiality of all work information.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
Estimated Pay Range:
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Department Name:
PHSO Med Claims ReviewWork Shift:
DayJob Category:
Clinical CareYou have a place in the health care industry. If you’re looking to leverage your abilities to make a real difference – and real change in the health care industry – you belong at Banner Plans & Networks.
Banner Health is proud to be recognized on Forbes list of America’s Dream Employers 2027 for the third consecutive year. This recognition highlights our commitment to supporting team members through comprehensive benefits, opportunities for both personal and professional growth, inclusive and empowering work environments, and resources that promote a healthy work-life balance. Banner Health ranked 56 out of the 500 companies made the list.
This Remote Hybrid position, will work 4x10 hour weekday shifts.
Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY
This position audits the organization's RN Reviews/Case Managers for adherence to established policies and guidelines surrounding case reviews for medical necessity. Uses critical thinking to audit clinical documentation confirming appropriate application of evidence based clinical criteria and proprietary tools and adherence to established productivity requirements. The position requires a sound knowledge of applicable regulations, including Medicare and Medicaid and has an understanding of our large commercial plans. Conducts telephonic audits, ensuring adherence to Banner’s Core Behaviors.
CORE FUNCTIONS
1. Performs audits for inpatient and/or outpatient cases, procedural processes and other potential compliance risk areas. Audits medical records to monitor compliance ensuring adherence to established processes and workflows. Identifies areas of potential risk through audit processes, as well as assists with presentation of audit findings and design and monitoring of necessary corrective action.
2. Researches regulatory and medical necessity requirements and develops audit tools and report forms at the direction of the Care Management leadership.
3. Identifies training opportunities based on audits, designs and presents such education to prevent repeated compliance risks at the direction of the compliance leadership team. Provides compliance/documentation education sessions to Medical Directors of Care Coordination (MDCC) RN Reviewers, Case Managers and other staff.
4. Acts as a knowledge resource to the registration staff as to requirements for compliance with specific regulatory and accreditation requirements for federal, state and third party agencies. Pursues and participates in education to remain current with changes in the healthcare and insurance industries. As assigned, provides training for RN Reviewer/Case Management staff and other staff.
5. Assists the organization's compliance officers, as directed, to research and investigate complaints, concerns or questions relative to compliance issues. Investigates and follows up on reported issues as directed.
6. Maintains awareness of laws and regulations and conducts research as needed to identify applicable laws, regulations and practices to maintain compliance. Reviews related policies and procedures and literature. Communicates applicable medical necessity compliance issues to Care Management leadership and assists in the distribution of training of such changes.
7. Assumes additional responsibilities to assist and support the organization's compliance program often dealing with complex and unique situations and problems.
8. Performs job functions on a system-wide basis. Internal and external customers include, but are not limited to, executives and managers, compliance committees, physicians and clinical staff.
MINIMUM QUALIFICATIONS
Requires knowledge typically gained with completion of a bachelor's degree in nursing or related field.
Registered Nurse (R.N.) licensure in the state of practice.
Requires skills and abilities normally acquired with two to three years of clinical experience and/or five years of experience as an RN Reviewer. Must be able to understand, apply and interpret complex case reviews and be able to work closely with our MDCC’s and others in a variety of settings.
Requires clinical knowledge, critical and analytical thinking skills to conduct compliance audits and draft reports. Computer skills in word processing and spreadsheets required. Ability to organize workload, manages multiple projects, and maintain confidentiality of all work information.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
Estimated Pay Range:
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Nurse Auditor Jobs by Experience Level
See All 11 Nurse Auditor Jobs
Find roles that match your experience and apply in just a few clicks.
Find Nurse Auditor JobsNurse Auditor Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Healthcare & Medical Services
What Employers Look For
The qualifications that appear most often in nurse auditor jobs.
- Active registered nurse license with at least two to three years of clinical experience
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential preferred or required
- Working knowledge of ICD-10-CM/PCS and CPT coding guidelines
- Experience with clinical documentation improvement or revenue cycle auditing
- Familiarity with Medicare, Medicaid, and commercial payer billing requirements
- Proficiency in electronic health record systems and audit documentation software
Tips for Your Nurse Auditor Job Search
Tailor your resume to audit findings
Hiring managers want to see that you've caught something. Quantify your audit results by describing the types of discrepancies you identified and the clinical areas you reviewed, not just your job duties. Vague summaries of responsibilities lose out to specific audit outcomes.
List your coding credentials front and center
Certifications like CPC, CCS, CCDS, or CDIP often act as a filter before a human reads your resume. Place them in your header or immediately below your name so they're visible before a recruiter scrolls down.
Target postings by payer type, not just title
Nurse auditor roles differ significantly between commercial insurers, Medicare Advantage plans, and hospital revenue cycle departments. Identify which payer environment matches your background and filter your search accordingly to avoid wasting applications on mismatched settings.
Apply early to roles that fit
Migrate Mate lists nurse auditor openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for scenario-based interview questions
Interviewers will ask you to walk through how you'd handle a disputed audit finding or a provider pushback situation. Practice explaining your clinical reasoning and your documentation standards out loud before you get to that stage.
Negotiate using scope, not just title
When discussing offers, ask about the volume of charts reviewed per period, the appeals workload, and whether you'll specialize in one service line or audit across multiple. Scope and workload affect your day-to-day far more than a title difference of one level.
Nurse Auditor Jobs: Frequently Asked Questions
Which companies are hiring the most nurse auditors?
The most active employers for nurse auditors right now are Guidehealth, Banner Health, and SCAN Health Plan, and the most openings are in Texas, California, and Florida, based on current listings on Migrate Mate as of November 2026. Demand tends to concentrate at large health systems, managed care organizations, and government payers running compliance or revenue integrity programs.
How many nurse auditor jobs are remote?
About 88% of nurse auditor openings are fully remote or hybrid as of November 2026, reflecting how thoroughly the role shifted during and after the pandemic. Retrospective coding audits, clinical documentation improvement review, and Medicare Advantage chart review are the sub-areas most likely to be fully remote, while prospective audits tied to real-time patient care tend to require on-site presence.
How do you become a nurse auditor?
Start with an active registered nurse license and build clinical experience in a setting where documentation and coding accuracy matter, such as acute care or a specialty unit. From there, pursue a coding credential like CPC or CCS to demonstrate your understanding of billing guidelines. Many nurses then move into a hybrid clinical documentation or utilization review role before stepping fully into audit work.
Can you get hired as a nurse auditor without audit experience?
Yes, especially if your clinical background is in a high-documentation area like critical care, orthopedics, or oncology, where chart complexity mirrors what auditors review. Employers hiring for entry-level audit roles often prioritize strong coding credentials and clinical depth over direct audit experience. Framing prior experience around accuracy, compliance, or quality improvement in your resume helps close that gap.
What does the nurse auditor interview process look like?
Most processes include an initial phone screen with HR, followed by a technical interview where a clinical or compliance manager walks through your coding knowledge and your approach to disputed findings. Some employers include a practical exercise, such as reviewing a sample chart and identifying documentation gaps or coding errors. Final rounds often involve a panel with the revenue integrity or compliance leadership team.
Where can I find and apply to nurse auditor jobs?
You can find and apply to nurse auditor jobs on Migrate Mate, which lists current openings from across the United States. Search the roles that fit your clinical background and coding credentials, and apply directly to each listing that matches your experience.
See All 11 Nurse Auditor Jobs
Find roles that match your experience and apply in just a few clicks.
Find Nurse Auditor Jobs