Hybrid Nurse Manager: Clinical Integrity & Oversight

State of Georgia; Atlanta (GA); Hybride; USD 62 000 - 88 000; Plein temps

Résumé du poste

The State of Georgia’s Department of Community Health seeks a Clinical Support Manager to lead the Office of Inspector General, Program Integrity Unit. You will supervise three nurses, analyze Medicaid claims, and perform desk and onsite reviews to ensure payment integrity and medical necessity.

This hybrid role requires an active Georgia RN license and a BSN, with several years of nursing and supervisory experience, and may involve testimony at administrative hearings.

Qualifications

• Bachelor's degree in nursing from an accredited college or university.
• Current Georgia license as a Registered Professional Nurse.
• Four years of experience as a Registered Nurse, with two years in admin or supervisory roles.

Responsabilités

• Directly supervise three staff members investigating Medicaid fraud, waste and abuse.
• Perform utilization reviews of providers enrolled in Fee-for-Service Medicaid.
• Analyze claims data to identify aberrant billing and determine medical necessity.
• Conduct desk and on-site reviews of medical records at provider locations.
• Provide guidance to the team and ensure adherence to performance metrics; may testify in hearings.

Connaissances

Supervisory experience

Administrative skills

Nursing license

Formation

Bachelor's degree in nursing

Description du poste

The State of Georgia’s Department of Community Health seeks a Clinical Support Manager to lead the Office of Inspector General, Program Integrity Unit. You will supervise three nurses, analyze Medicaid claims, and perform desk and onsite reviews to ensure payment integrity and medical necessity.

This hybrid role requires an active Georgia RN license and a BSN, with several years of nursing and supervisory experience, and may involve testimony at administrative hearings.