Registered Nurse Subject Matter Expert
Job Summary
To support an upcoming contract, the full-time Remote Nurse Subject Matter Expert (SME) will provide clinical expertise in program integrity initiatives, audits, and fraud prevention while collaborating with various stakeholders to enhance healthcare outcomes.
Key responsibilities
- Provide clinical support for audits, investigations, and data analysis related to healthcare programs
- Collaborate with clients and stakeholders to develop tools and strategies for program integrity initiatives
- Analyze healthcare data and medical records to identify vulnerabilities and recommend compliance improvements
Required qualifications
- Active, unrestricted Registered Nurse (RN) license in at least one U.S. state or territory
- Bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related field
- 10+ years of clinical and healthcare industry experience, including medical record review and clinical auditing
- Demonstrated expertise in reviewing medical records, claims data, and clinical documentation
- Strong knowledge of risk adjustment methodologies and healthcare quality improvement initiatives
Complete Job Description
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