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, investigations, and healthcare reviews while collaborating with internal teams and external stakeholders to enhance compliance and operational effectiveness.
Key responsibilities
- Provides clinical support for audits, data analysis, and investigations requiring subject matter expertise
- Collaborates with clients and stakeholders to develop tools and references that support program integrity initiatives
- Analyzes healthcare data and medical records to identify vulnerabilities and develop recommendations for compliance and quality improvement
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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