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Qlarant
Nurse Specialist II
Remote · United States · Full time · Mid level
$57.5k–$85.8k / year
About the role
Perform medical record and claims review to ensure compliance and assess potential overpayment, fraud, waste, and abuse for Medicare, Medicaid, and other claims.
What you’ll do
• Review beneficiary, provider, and pharmacy cases for overpayment and fraud. • Complete desk reviews and field audits per contract requirements. • Consult with investigation experts and pharmacists. • Provide case summaries to support investigations. • Participate in onsite visits, interviews, and legal proceedings.
What you’ll bring
• Bachelor's degree minimum or equivalent experience. • 2-4 years medical review experience required. • Experience with Medicare or Medicaid preferred. • Current, active, non-restricted RN licensure required. • Coding certification preferred.
Life at Qlarant
Qlarant offers a drug-free workplace and equal opportunity employment with pre-employment background and drug screening.
About Qlarant
Qlarant is a not-for-profit corporation partnering with public and private sectors to deliver high quality healthcare and human services programs, including fraud prevention and quality assurance.