Clinical InvestigatorPosted today$75K–$99K
Remote · WorldwideHealthcare
The opportunity
Hi, we're Oscar. We're hiring a Senior Analyst, Special Investigations Unit Clinical Investigator to join our SIU.
What you'll do
Identify and conduct clinical audits into suspected FWA with high autonomy
Document findings, to include formal reports, graphs, audit logs, and other supporting documentation.
Metrics to align with unit goals.
Participate in the development and presentation of FWA-related education for Oscar teams
Compliance with all applicable laws and regulations
Other duties as assigned
What they're looking for
- Active, unrestricted Registered Nurse (RN) license
- + years of direct patient care clinical experience. Case Management experience a bonus.
- + years of experience in Medical Review, Utilization Management, or Clinical: Documentation Improvement, featuring demonstrated expertise in the forensic application of complex clinical guidelines (e.g., MCG, CMS, and specialty-specific professional organizations) to multifaceted medical records.
- Experience conducting forensic medical audit with a focus on validating that: clinical narrative supports the specificity and necessity of billed CPC, HCPCS, and ICD-10 codes.
