Clinical Support Manager, Nursing – Hybrid

State of Georgia

High Springs (FL)

Híbrido

USD 62.000 - 88.000

Jornada completa

Hace 4 días

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Descripción de la vacante

The State of Georgia seeks a Clinical Support Manager in the Office of Inspector General, Program Integrity Unit. This hybrid, full-time role leads a small team of nurses who investigate providers for fraud, waste, and abuse in Georgia's Medicaid program and conduct utilization reviews to ensure claim payment integrity.

The Clinical Support Manager analyzes claims data, reviews medical records, and may testify in administrative hearings.

Formación

Bachelor's degree in nursing from an accredited college or university.
Four (4) years of experience as Registered Nurse, two (2) years in an administrative or supervisory capacity and current Georgia license as a Registered Professional Nurse; or eight (8) years of experience at the lower level as a Registered Nurse, two (2) years in an environment related to the area of assignment, three (3) years as a supervisor and current Georgia license as a Registered Professional Nurse.

Responsabilidades

Manage three direct reports charged with investigating providers for fraud, waste, and abuse in the Fee-for-Service Medicaid program.
Analyze claims data to identify aberrant billing trends.
Conduct desk and onsite utilization reviews at provider locations to evaluate medical necessity and support claims payments.
Provide guidance to ensure adherence to performance metrics and timely business processes for the Program Integrity Unit.