
The Program Integrity Clinical Reviewer II role supports CareSource's investigative and audit teams by evaluating medical records for documentation accuracy, coding compliance, and potential fraud. Key responsibilities include conducting claim reviews against clinical standards, presenting findings to medical directors, developing training materials, and collaborating with cross-functional departments to improve policies. This position is appealing for professionals seeking to leverage their clinical background and coding expertise in a collaborative environment that values continuous learning and professional development. The role requires a current RN license and coding certification, with a preference for readmission and fraud investigation experience. The position operates within a general office setting.



















