Remote Nurse SME – Program Integrity & Data Analytics

J29 Inc.

Northern (KY)

Hybrid

USD 100,000 - 120,000

Full time

14 days+

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Job summary

J29, Inc. seeks a highly experienced Nurse Subject Matter Expert (SME) to support a potential contract.

The role is remote and focuses on program integrity, audits, data analysis, and quality improvements within healthcare data and medical records. The Nurse SME will collaborate with health plans, providers, and stakeholders to identify vulnerabilities, develop recommendations, and ensure compliance with CMS STAR and risk-adjustment related activities.

Qualifications

RN license in at least one U.S. state or territory.
Bachelor's degree in Nursing or related field required.
10+ years clinical/healthcare industry experience including audits and data analysis.
Strong analytical skills and ability to interpret clinical data and claims.

Responsibilities

Provide clinical SME support for program integrity initiatives, audits, data analysis, and investigations.
Collaborate with clients, health plans, and providers to support data sharing and tool development.
Lead design and implementation of projects, with potential educational program delivery.
Develop best practices for audits, analytics, and vulnerability studies.
Review encounter data and claims to advise on compliance and quality improvements.