Nursing Auditor

Description

Job Summary: A professional responsible for the technical and administrative analysis of healthcare and regulatory requests, providing strategic support to management on topics such as preliminary injunctions and NIPs. Key Highlights: 1. Strategic involvement in sensitive topics such as preliminary injunctions and NIPs. 2. Ensures compliance with ANS guidelines and provides technical support. 3. Critical analysis of processes and identification of risks. **About the Position:** A professional responsible for the technical and administrative analysis of healthcare and regulatory requests, with strategic involvement in supporting management on sensitive topics such as preliminary injunctions, NIPs, and administrative proceedings. Evaluates requests, supports prospective audits (surgical, SADT, OPME, and therapies), and structures technically grounded responses, ensuring compliance with ANS guidelines and providing technical support for decision-making—without final deliberative authority. **Key Responsibilities:** * Evaluate healthcare requests according to the ROL, DUTs, TUSS, and current regulations; * Provide technical support for prospective audits (surgical, SADT, OPME, and therapies); * Analyze administrative and judicial requests (preliminary injunctions and NIPs) and structure technically substantiated responses; * Gather technical evidence to support the health plan operator’s defense based on healthcare and regulatory guidelines; * Support the analysis and approval of therapies, including ABA (Applied Behavior Analysis); * Interface with clinical teams, legal department, regulation team, and other internal areas; * Organize and consolidate information to support management decision-making; * Assist in developing workflows, protocols, and standardizations for the area; * Contribute to critical analyses of processes and identification of healthcare and regulatory risks. **Mandatory Technical Requirements:** * Completed high school education (ongoing undergraduate studies will be considered a plus); * Solid knowledge of: + TUSS; + ANS ROL and DUTs; + Healthcare regulation within health plan operators; + Surgical analysis and clinical protocols; + Authorization and regulation processes; * Analytical ability to read and interpret medical orders, reports, referral forms, and protocols; * Intermediate Excel proficiency (data management, indicators, and basic analysis). **Preferred Qualifications:** * Familiarity with the Solus system; * Postgraduate degree in Auditing; * Experience analyzing administrative and judicial requests (NIPs and preliminary injunctions); * Experience or familiarity with serial and specialized therapies (e.g., ABA); * Analytical and critical profile for technical evaluation of healthcare requests.