Employer Industry: Healthcare Compliance

Why Consider this Job Opportunity:
- Salary up to $[highest pay]
- Opportunity for career advancement and growth within the organization
- Work remotely with occasional travel to conduct audits/investigations
- Access to medical and personnel records to support investigations
- Utilize clinical knowledge to determine the appropriateness of documented services
- Collaborate with a Special Investigations Unit and other stakeholders

What to Expect (Job Responsibilities):
- Conduct audits/investigations and prepare detailed reports
- Develop audit/investigation plans and tools based on alleged non-compliance and data analytics
- Collect and document evidence systematically and accurately
- Conduct interviews with providers and other witnesses
- Track allegations of fraud, waste, and abuse in a case management system

What is Required (Qualifications):
- Graduation from an accredited school of Nursing with an RN license and 5 years of relevant post-graduate experience, OR a Master's degree in a relevant field and 5 years of relevant post-graduate experience
- Current, unencumbered clinical license as an LCSW, LCMHC, LMFT, LCAS, LPA, or RN
- Knowledge of healthcare industry, Medicaid laws, and investigative methods
- Proficiency in Microsoft Office products
- Strong verbal and written communication skills

How to Stand Out (Preferred Qualifications):
- Health care industry and/or Medicare/Medicaid/Behavioral Health experience and knowledge
- SIU and/or regulatory compliance work experience
- National Certified Investigator and Inspector Training (NCIT) Basic and Specialized

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