J1126-0362

Create your profile | Sign in Activate career alerts Find similar career opportunities Position Description: CGI 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: • 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: • 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 Other Information: CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $70,800.00 $123,800.00. CGI's benefits are offered to eligible professionals on their first day of employment to include: . Competitive compensation . Comprehensive insurance options . Matching contributions through the 401(k) plan and the share purchase plan . Paid time off for vacation, holidays, and sick time . Paid parental leave .Learning opportunities and tuition assistance . Wellness and Well being programs CGI Federal anticipates accepting applications for this position through 2026 12 31. Skills: Communication MS Office365 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. Come join our team—one of the largest IT and business consulting services firms in the world. Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business. CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at [email protected] . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned. We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members. All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances. CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information. Have you been referred by a CGI Partner for this position? * Yes No CGI Partner’s email (@cgi.com) * First Name Last Name I agree to allow CGI to contact the CGI Partner who referred me to obtain additional information about my application and confirm my referral. * * This field is required. CGI is an Equal Opportunity Employer, to include disability and protected veteran status; we are committed to compliance with U.S. laws and regulations. Click here to access an overview of our U.S. Equal Employment Opportunity and Anti-Harassment Policy. Applicants have rights under Federal Employment Laws: EPPA FMLA Know Your Rights: Workplace Discrimination is Illegal Pay Transparency Statement Policy CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at [email protected] . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned. We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.