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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Clinical Auditing, Quality Review, and Readmission Review, with a strong focus on compliance, documentation accuracy, and evidence-based decision-making. Proficient in providing feedback, conducting root cause analysis, and maintaining quality standards in healthcare settings.
Highest-signal resume keywords
Registered Nurse LicenseClinical AuditingQuality ReviewRoot Cause AnalysisHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AuditingQuality ReviewRoot Cause AnalysisMedical Record ReviewAudit ValidationDocumentation RequirementsEvidence-Based Quality DeterminationsTrend IdentificationQuality FeedbackDischarge Planning
Soft Skills
Excellent Written CommunicationExcellent Verbal CommunicationAnalytical SkillsAttention to DetailProfessional Feedback
Tools & Technologies
ExcelWordOutlookOneNoteGeneral Computer Applications
Certifications & Qualifications
Active RN License
Industry Keywords
Potentially Preventable ReadmissionsAudit SamplingClinical JudgmentQuality Control ReviewTransitions of Care
About the role
Key responsibilities & impact- Oversee work performed by Clinical Readmission Review Auditors
- Perform quality reviews of random and targeted samples of completed readmission audits
- Validate findings, no-findings, clinical rationale, and supporting documentation
- Follow approved sampling methodology for random, targeted, and follow-up quality reviews
- Apply quality scoring criteria to evaluate audit accuracy, documentation quality, and adherence to program expectations
- Confirm readmission determinations are supported by medical records, clinical criteria, client requirements, and internal procedures
- Review audit documentation for clarity, completeness, grammar, evidence-based support, and alignment with quality expectations
- Provide feedback and coaching support to auditors
- Identify audit trends, missed opportunities, recurring errors, and potential referrals for additional review or escalation
- Perform root cause analysis and recommend corrective actions
- Support calibration discussions, quality monitoring, procedure updates, and training opportunities
- Document quality review outcomes, audit findings, supporting rationale, error trends, and recommended next steps
- Maintain quality review results and reporting for performance monitoring, trend analysis, and leadership review
- Communicate quality results, barriers, trends, and improvement recommendations to peers and management
- Follow company compliance, information security, HIPAA, and regulatory policies
Requirements
What you’ll need- Registered Nurse, Associate’s or Bachelor’s degree required
- Active, unrestricted RN license in the United States required
- 5+ years of acute care nursing, utilization review, clinical auditing, readmission review, quality review, or related healthcare experience preferred
- Prior readmission, potentially preventable readmission, quality control, secondary review, peer review, audit validation, or clinical audit quality monitoring experience preferred
- Knowledge of potentially preventable readmission concepts, readmission drivers, discharge planning, transitions of care, and medical necessity preferred
- Strong knowledge of inpatient medical record review, discharge planning, readmission drivers, medical necessity, transitions of care, and documentation requirements
- Ability to synthesize complex inpatient medical record documentation and make objective, evidence-based quality determinations
- Excellent written and verbal communication skills, analytical skills, attention to detail, and ability to provide professional feedback
- Proficient in Excel, Word, Outlook, OneNote, and general computer applications
- Ability to work independently in a remote environment and deliver results during EXL core business hours
- Knowledge of Clinical Readmission Review, Quality Control Review, Audit Sampling, Medical Record Review, Clinical Judgment, Potentially Preventable Readmissions, Root Cause Analysis, Quality Feedback, Calibration, Trend Identification, Written Communication, and HIPAA Compliance
Benefits
Comp & perks- 100% remote, U.S.-based work opportunity
- Up to 10% annual travel
- Benefits information provided at https://www.exlservice.com/us-careers-and-benefits