Training Specialist, Medical Review Audit – Clinical RN

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Training Specialist, Medical Review Audit – Clinical RN based in the United States. This is a specialized clinical training role focused on strengthening the quality and consistency of post-acute medical claims auditing. You will combine hands-on nursing expertise with adult learning and instructional design to develop training for clinical audit professionals. The role has a strong focus on Inpatient Psychiatric Facility (IPF) and Inpatient Rehabilitation Facility (IRF) claims, with additional exposure to Home Health and DME. You will translate complex clinical, regulatory, coding, and payment requirements into practical, audit-ready learning experiences. Your work will directly influence auditor accuracy, productivity, quality outcomes, and the effectiveness of new program implementations. Working closely with operations, QA, compliance, and other stakeholders, you will identify knowledge gaps and build targeted improvement programs. This opportunity is ideal for an experienced RN and healthcare audit professional who enjoys combining clinical subject matter expertise with measurable training outcomes Design, develop, and maintain comprehensive training curricula for clinical audit nurses and associates covering post-acute claims review, documentation, medical necessity, coding, and payer policies. Create structured onboarding, continuing education, competency, remediation, and implementation programs, supported by job aids, reference materials, assessments, and other learning resources. Translate complex clinical and regulatory requirements into clear training content covering areas such as IPF PPS, IRF PPS, DSM-5 diagnostic criteria, level-of-care distinctions, facility billing rules, and related audit concepts. Maintain training content in the Learning Management System (LMS), ensuring materials remain accurate, accessible, and effective for remote delivery. Deliver training through virtual classrooms, small-group sessions, and one-to-one formats while adapting delivery to different experience levels. Track training completion, assessment results, audit accuracy, QA outcomes, appeals trends, and other performance indicators to measure program effectiveness. Identify knowledge and performance gaps through audit data, quality results, appeals, and observation, then design and implement targeted remediation plans. Conduct User Acceptance Testing for new audit platform workflows and reporting enhancements and incorporate relevant findings into training programs before launch. Serve as a clinical subject matter expert for IPF and IRF audit requirements, including medical necessity, documentation, payment rules, coding, and level-of-care determinations. Train auditors on IPF requirements such as qualifying psychiatric diagnoses, physician certification and attestation, treatment plans, daily progress notes, safety assessments, and ECT add-on billing. Train auditors on IRF requirements including the 60%/75% compliance rule, pre-admission screening, IRF-PAI timelines, the 3-hour therapy rule and exceptions, interdisciplinary team conferences, individualized care plans, and CMG assignment. Monitor changes to CMS regulations, LCD/NCD criteria, coding guidelines, and clinical standards and proactively update training materials and communicate changes. Partner with operations, QA, compliance, and management to align training with business objectives, client requirements, workflows, and implementation timelines. Provide consultative input into audit platform requirements, workflow design, business rules, process improvements, and medical review initiatives. Requirements Active, unrestricted nursing license in good standing, with no Medicare program sanction or exclusion by OIG. Bachelor’s degree in Nursing, Health Information Management, Education, or a related field, or equivalent relevant qualifications.