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CP
Confidential Posting
RNAC
Career Insights for Clinical Auditor / Utilization Reviewer
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Scorecard
Based on Pennsylvania data
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What they do
A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
$95,917 / year median in Pennsylvania
-9% projected decline
Job Description
Position Summary We are seeking an experienced and detail-oriented RN Assessment Coordinator (RNAC) to join our team. The RNAC is responsible for coordinating and completing the MDS process in accordance with federal and state regulations while ensuring accurate clinical documentation and optimal reimbursement. This role works closely with the interdisciplinary team to ensure quality resident care and compliance with all regulatory requirements. Key Responsibilities Complete and oversee all MDS assessments (admissions, quarterly, annual, significant change, PPS, OBRA, etc.) Ensure timely and accurate submission of MDS assessments Coordinate and lead care plan meetings with interdisciplinary team Ensure care plans are accurate, individualized, and updated regularly Monitor and support PDPM accuracy and reimbursement optimization Review clinical documentation to ensure it supports coding and reimbursement Collaborate with nursing, therapy, and administration to ensure compliance Participate in Medicare meetings and triple check process Maintain compliance with all CMS, state, and facility guidelines Assist with surveys, audits, and regulatory reviews Qualifications Current Registered Nurse (RN) license in Pennsylvania Minimum 1-2 years of