Texas Licensed Clinical Investigator

Job Summary

A company is looking for a Clinical Investigator, SIU.

Key Responsibilities:

• Identify and conduct clinical audits into suspected fraud, waste, and abuse (FWA) with high autonomy
• Document findings, including formal reports, graphs, and audit logs
• Participate in the development and presentation of FWA-related education for teams

Required Qualifications:

• Active, unrestricted Registered Nurse (RN) license
• 3+ years of direct patient care clinical experience; case management experience is a bonus
• 2+ years of experience in Medical Review, Utilization Management, or Clinical Documentation Improvement
• Experience conducting forensic medical audits related to clinical narrative and coding validation
• Bonus points for relevant degrees or certifications in nursing and healthcare fraud investigation