New York Licensed Clinical Review Nurse

Job Summary

A company is looking for a Fraud, Waste and Abuse (FWA) Clinical Review Registered Nurse.

Key Responsibilities

• Conduct detailed clinical record reviews to identify potential fraud, waste, and abuse
• Assess medical necessity, coding accuracy, and documentation integrity
• Collaborate with various teams to resolve identified issues and provide clinical education

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license
• 5-7 years of clinical experience, particularly in inpatient and ambulatory clinical documentation
• Experience in clinical record review, compliance, or audit functions
• Strong understanding of medical necessity and healthcare regulations
• Proficiency with electronic health records (EHRs) and clinical documentation systems