Pre-Payment Review Nurse Consultant- Wisconsin
$86,000–$105,000 year
Remote · Wisconsin, United States
Job Summary
Office of Inspector General pre-payment nurse consultant role focusing on clinical and financial pre-payment compliance reviews to detect fraud, waste, and abuse in Medicaid; develops and implements pre-payment review criteria; conducts comprehensive medical record reviews and analyzes datasets; requires deep knowledge of Medicaid/Medicare regulations, GAAS, and capability to communicate findings and recommendations clearly; remote 100% within Wisconsin residency; strong clinical background across pediatric and adult populations; opportunities for policy development, research methods, and system analysis.
Required Qualifications
- Current Wisconsin Registered Nurse license issued by the Wisconsin Department of Safety and Professional Services.
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