Registered Nurse Medicaid Reviewer

A company is looking for a Medicaid Medical Review Subject Matter Expert.

Key Responsibilities

Collaborate with Data Analysis and Program Integrity teams to conduct proactive studies meeting CMS requirements

Research state Medicaid regulations and develop criteria for medical review attributes

Finalize Medical Review criteria for submission to states and CMS and maintain relationships with Medicaid agencies

Required Qualifications, Training, and Education

Bachelor's Degree or equivalent related experience

Priority consideration for candidates with an active Registered Nurse (RN) license

Minimum of four years of experience in Medicaid fraud investigations or one year with an advanced degree

Strong Medicaid research abilities

Knowledge of statistics and data analysis techniques preferred