Clinical Nurse Auditor

CGI is one of the world's largest independent IT and business consulting services firms. We partner with commercial and government clients to deliver innovative technology and business solutions that improve outcomes for millions of people. At CGI, you'll join a collaborative, client-focused organization where your expertise helps deliver meaningful impact while supporting continuous learning and professional growth.

About the role

CGI is seeking a Clinical Nurse Auditor to join our Clinical Services Group (CSG) Clinical Audit Team. In this role, you will conduct comprehensive clinical audits of medical records to determine the medical appropriateness and necessity of healthcare services provided to members of commercial and government health plans. Your expertise will support the identification of improper payments while ensuring audit decisions are objective, well-supported, and aligned with applicable clinical guidelines, regulatory requirements, and client-specific policies.

As a Clinical Nurse Auditor, you will leverage your critical thinking, clinical expertise, and strong documentation skills to review inpatient and outpatient claims, evaluate medical necessity, validate clinical services, and prepare detailed audit determinations. You will receive comprehensive training on CGI's audit methodologies, documentation standards, and proprietary tools while participating in ongoing education related to clinical procedures, disease states, regulatory changes, and audit best practices. This position is remote within the United States, and candidates must be available to work Eastern Time Zone business hours.

Responsibilities

• Conduct inpatient and outpatient clinical audits to evaluate medical necessity, reasonable and necessary services, prior authorization validation, clinical validation, medical service charge audits, and other audit types as required
• Review medical records and provider documentation to identify unsupported services and recover improper payments in accordance with client contracts and regulatory guidelines
• Develop comprehensive audit rationales supported by clinical documentation, established review criteria, applicable regulations, and internal audit guidelines
• Accurately document audit findings and determinations within CGI's audit platforms while maintaining thorough, well-organized case records
• Collaborate with Physician Advisors and internal clinical specialists when required to support complex clinical determinations
• Support Clinical Validation and DRG validation activities by documenting coding-related findings in partnership with specialized review teams
• Maintain departmental productivity, quality, inter-rater reliability, and performance standards while meeting established deadlines
• Communicate effectively with leadership regarding workload, scheduling, operational issues, and performance barriers while adhering to CGI corporate policies and compliance requirements

Requirements

• Active, unrestricted Registered Nurse (RN) license in your state of residence
• Minimum of 5 years of recent Intensive Care Unit (ICU) or Critical Care Unit (CCU) nursing experience
• Strong clinical knowledge with the ability to evaluate complex medical records across multiple healthcare settings
• Experience interpreting clinical documentation to support medical necessity and utilization review determinations
• Excellent written communication skills with the ability to prepare detailed, well-supported clinical narratives using proper grammar and documentation standards
• Strong proficiency with Microsoft Office applications including Outlook, Word, and Excel, along with Windows-based operating systems
• Ability to work independently, manage multiple priorities, and consistently meet productivity and quality expectations
• Strong critical thinking, analytical, and decision-making skills with exceptional attention to detail
• Willingness to work Eastern Time Zone hours and travel up to 25% as needed for training or onsite audit activities

Qualifications

• Previous experience performing medical record audits, utilization review, payment integrity, or clinical claim review
• Experience reviewing Commercial and Government healthcare claims
• Familiarity with medical necessity criteria, healthcare regulations, and payer audit processes
• Experience with clinical documentation improvement (CDI), DRG validation, or payment integrity programs
• Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), or other relevant healthcare certifications
• Bachelor's degree in Nursing (BSN) or an advanced nursing degree

Pay

A reasonable estimate of the current range for this role in the U.S. is $70,800.00 - $123,800.00.

Benefits

• 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

About CGI

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.