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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical readmission review, quality auditing, and documentation analysis, ensuring compliance with healthcare standards and regulations. Proficient in providing feedback, conducting root cause analysis, and synthesizing complex medical records to enhance quality outcomes.
Highest-signal resume keywords
Registered NurseClinical AuditingQuality ReviewHIPAA ComplianceAnalytical Skills
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 Readmission ReviewAudit ValidationDocumentation RequirementsQuality Scoring CriteriaRoot Cause Analysis
Soft Skills
Excellent Written CommunicationAttention to DetailProfessional Feedback
Tools & Technologies
ExcelWordOutlookOneNote
Certifications & Qualifications
Active RN License
Industry Keywords
Acute Care NursingUtilization ReviewMedical NecessityTransitions of CareDischarge Planning
About the role
Key responsibilities & impact- Apply clinical judgment and readmission review knowledge to ensure the accuracy and consistency of completed Clinical Readmission Review audits
- Perform quality reviews of random and targeted samples of Clinical Readmission Review Auditor work
- Validate findings, no-findings, clinical rationale, and supporting documentation
- Follow approved sampling methodology for random, targeted, and follow-up quality reviews
- Apply established 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 Clinical Readmission Review Auditors
- Identify audit trends, missed opportunities, recurring errors, and potential referrals for additional review or escalation
- Provide root cause analysis and recommend corrective actions
- Support calibration discussions, quality monitoring, standard operating procedure updates, and training opportunities
- Write professional communications documenting quality review outcomes, findings, 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
- Perform other duties as assigned
- Conduct responsibilities in accordance with company compliance, information security, HIPAA, regulatory policies, procedures, and programs
Requirements
What you’ll need- Registered Nurse required
- 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, identify quality errors or missed opportunities, and make objective, evidence-based quality determinations
- Excellent written and verbal communication skills
- Strong analytical skills and attention to detail
- Ability to provide professional feedback
- Proficiency 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
- HIPAA compliance knowledge
Benefits
Comp & perks- 100% remote, U.S.-based work opportunity
- Up to 10% annual travel
- Benefits information provided through EXL’s U.S. careers and benefits page