Qlarant, Inc., is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country.
Qlarant has exciting opportunity for a Registered Nurse with MR/UR experience, strong Medicare/Medicaid knowledge and investigative skills to join our Cerritos, CA based Unified Program Integrity Contractors (UPIC) team. Our UPIC team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering 16 Western states and territories. We're seeking candidates that possess strong analytical skills in addition to their clinical experience. Well qualified candidates should possess a sense of urgency and a track record of exceeding expectations.
The selected candidate can be based in our Cerritos, CA office or home-based within the UPIC Western jurisdiction (Arizona, California, Nevada, Utah, Oregon, Washington, Idaho, North Dakota, South Dakota, Wyoming, Montana, Alaska and Hawaii). In addition to a competitive compensation package, Qlarant offers excellent benefits that include two pension plans and generous vacation and sick leave accruals.
Please Note: Current, active and non-restricted RN license required. An LVN will not meet CMS requirements.
This is a mid-level professional position that works both independently and in a team environment that may be comprised of medical professionals, claims analysts, and auditors to perform medical record and claims review for Medicare, Medicaid, and/or other claims data in order to ensure that proper guidelines have been followed, as well as production of final review/audit report across all service and provider types, including, but not limited to, individual practitioners, institutions, and managed care entities to examine payments to providers. Where payments are not valid, establishes overpayments and initiates recoupment, revocation, or other administrative actions, as appropriate.
Primary duties include:
Other Skills and Abilities
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.