Nurse Consultant ()
Nurse Consultant ()
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$ 59732 - 98557
1 Vacancy
Job Description
Description of Work
Not sure you meet all listed requirements Let our team take a look. Research shows that women and members of other under-represented groups tend to not apply to jobs when they think they may not meet every qualification. We are committed to creating a diverse and inclusive environment and strongly encourage you to apply.
THE STARTING SALARY FOR THIS POSITION IS LIMITED TO$59732 - $88851. Salary offers for the selected candidate are based on the candidates education and experience related to the position as well as our agency budget and equity.
The Nurse Consultant is responsible for reviewing referrals made to the Medicaid Investigations Division (MID) involving allegations of patient abuse and neglect in Medicaid funded facilities and investigating the allegations for potential criminal violations and civil false claims violations.
The Nurse Consultant is responsible for investigating and supporting the statewide investigation of a wide variety of health care providers who are enrolled with the North Carolina Medicaid Program.
The Nurse Consultant is responsible for working with the Medicaid Investigations Division (MID) investigators and prosecutors in conducting case reviews of Medicaid claims data and medical records from health care providers enrolled with the North Carolina Medicaid Program to determine whether proper medical services were provided whether proper levels of care were provided whether any incidents or patterns of patient abuse occurred whether correct medical coding and billing was used whether services were medically necessary whether acceptable medical practice and standards of care were met whether medical providers complied with medical policy regulations and licensing requirements whether diagnoses were consistent with the treatment billed and whether any gaps in the providers medical documentation exist.
The Nurse Consultant is responsible for providing medical expertise and assistance to the MID prosecutors and investigators in the reviewing interpreting and analyzing medical and billing records compiling and organizing medical records and data pertaining to health care provider claims for reimbursement translating medical terminology understanding medical services and understanding and interpreting Medicaid Program rules regulations and policies.
Some travel including some overnight stays are required.
Selected candidate will undergo a background and records check.
Note to Current State Employees:
The salary grade for this position is MH16. State employees are encouraged to apply for positions of interest even if the salary grade is the same as or lower than their current position. Please detail ALL work history including non-state service experience. If selected for this position a new salary will be recalculated taking into consideration the quantity of relevant education and experience funding availability and internal equity. Based upon these factors a pay increase MAY or MAY NOT result.
The State of North Carolina offers employer paid health insurance plus twelve paid holidays generous vacation and sick leave accrual dental vision and other insurance options and retirement benefits. You can view our benefits information at Employee Benefits.Division Information:
The Medicaid Investigations Division is a law enforcement and prosecution organization primarily responsible for investigating and prosecuting medical assistance provider fraud and the abuse and neglect of Medicaid Recipients in Medicaid funded facilities. Included in the activities of the Division are the detection of fraudulent schemes by Medicaid providers targeting of potential defendants field investigation of suspects search and seizure of evidence of illegal activities maintaining custody of evidence arrest pretrial case preparation prosecution of criminal and civil actions in state and federal courts post-trial sanctioning and recovery of criminal fines civil penalties and restitution.
Department Information:
TheNorth Carolina Department of Justice led by the Attorney General of North Carolina represents the state state agencies and elected officials and defends the rights of the people of North Carolina. The Department handles all state criminal appeals cases and assists district attorneys with complex criminal cases at their request. Additionally the Department of Justice includes theNorth Carolina State Crime Lab theNorth Carolina Justice Academy and theSheriffsandCriminal Justice Education and Training Standards Divisions.Knowledge Skills and Abilities / Competencies
Management Preferences:
Experience in clinical nursing.
Experience analyzing medical and billing records for fraud.
Minimum Education and Experience Requirements
Licensed to practice as a Registered Nurse in the State of North Carolina and one year of experience in the area of specialization.
Supplemental and Contact Information
Note the following:If multiple applications are submitted to an individual posting only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 5:00 PM on the closing date.
Resumes and cover letters:To receive credit for your work history and credentials you must list the information on the online application form. This information is used to determine if you meet the requirements of the position and if you are selected it is used to determine a salary offer.
Using the terms See Resume or See Attachment will not be accepted and your application will be rejected as incomplete. Cover letters are highly encouraged but not required.
Transcripts:Degrees must be received from appropriately accredited institutions. A copy of your transcripts indicating the degree received can be uploaded with your application. If a transcript has been requested your application will be considered incomplete if you do not provide one. Using a photograph of your diploma is not acceptable.
Credit for foreign degrees will only be given if verification of degree certification is attached to your application. Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine US equivalency.
Any licenses or certificates must be included in the appropriate section of the application form.
Applicants seeking Veterans Preference must attach a copy of their DD-214 or discharge orders.
Applicants seeking National Guard Preference must attach a NGB 23A (RPAS) if you are a current member of the NC National Guard in good standing. If you are a former member of the NC National Guard who served for at least 6 years and was discharged under honorable conditions you must attach either a DD256 or NGB 22.
Application status:To check the status of your application please log in to your account. Upon the closing date applications are Under Review and will be screened by Human Resources for the qualified applicants. The hiring process may take an average of 6 8 weeks. All applicants will be notified by email once a position is filled.
If you are having technical issues submitting your application please call the NeoGov Help Line at . If there are any questions about this posting other than your application status please contact the NC DOJ Human Resources office.
The NC Department of Justice is an Equal Opportunity Employer. The NC Department of Justice uses Merit-Based Recruitment to select from among the most qualified applicants to fill positions subject to the State Human Resources Act.
CONTACT INFORMATION:
NC Department of Justice
Human Resources
Required Experience:
Contract
Employment Type
Full-Time
