Clinical Nurse Investigator
Location: Louisville, Kentucky
Description: Humana is looking of Clinical Nurse Investigator right now, this vacancy will be placed in Kentucky. For detail informations about this vacancy opportunity please read the description below. The purpose of this position is to work on the medical review component of fraud investigations and provide clinical expertise. Investigator will work closely with other members of the RAIU to develop cases and provide support on active cases to include medical record reviews and other investigational steps as needed.
Responsibilities include but are not limited to:
- Assist with case development by providing clinical expertise when performing medical record reviews
- Identify fraud schemes and trends within the assigned line of business or specialties
- Ability to review medical records adhering to department policies and processes
- Ability to testify on behalf of findings
- Support RAIU on complex cases as needed
- Collaborate with other members of the investigative team
Registered Nurse with current license
Bachelor’s degree from four year college/university
Strong clinical experience to include multiple practice areas
Minimum 2 years of healthcare auditing experience
Knowledge of healthcare payment methodologies
Prior healthcare fraud investigations experience
Strong organizational, interpersonal, and communication skills
Inquisitive nature with ability to analyze data to metrics
Computer literate (MS, Word, Excel, Access)
Strong personal and professional ethics
Role Desirables
5 + years of Fraud/Auditing experience.
Understanding of healthcare industry, claims processing and investigative process development.
Experience in a corporate environment and understanding of business operations
Knowledge of Humana systems to include CAS, CCP2, MRM and Mediconnect.
Reporting Relationships
You will report to the department manager. This area is under the leadership of the SVP & Chief Operating Officer
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana. After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.
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If you were eligible to this vacancy, please give us your resume, with salary requirements and a resume to Humana.
Interested on this vacancy, just click on the Apply button, you will be redirected to the official website
Apply Clinical Nurse Investigator Here
This vacancy starts available on: Mon, 22 Jan 2018 21:14:17 GMT
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