Nurse Analyst, Medicaid Fraud, Chicago or Oakbrook 23-E-06

Nurse Analyst

The Nurse Analyst is responsible for collecting, analyzing, and screening information from a variety of sources and is required to use that information to determine whether patient abuse, neglect, prescription drug diversion, fraud, waste, or abuse has occurred. The Nurse Analyst will assist in the evaluation and creation of investigative strategies and case objectives; evaluate the physical and mental status of victims; and assist with interviews of individuals and/or witnesses involved with alleged fraud or abuse cases.

The Nurse Analyst will be responsible for writing reports; creating summary exhibits of findings; maintaining accurate records and files; and testifying in court and before the grand jury. Additionally, they will review, analyze, interpret, and prepare detailed summaries of: medical records; charts; progress notes; medication administration records; Minimum Data Set resident assessment instruments; ICD-9/10 coding; CPT coding; and, Medicaid claims/utilization data.

Qualifications

This position requires a Bachelor's degree in nursing; a current license to practice as a Registered Nurse (RN) in good standing in the State of Illinois; and, a minimum of three (3) years of experience as a nurse practicing as a RN. Knowledge of state and federal rules and regulations related to health care and health care facilities particularly in the Medicaid program is desired along with work experience in patient/resident care settings (long-term care, assisted living, home health, hospice, hospital, group homes). The ability to define problems, collect data, or information; establish facts and draw valid conclusions; ability to prepare meaningful, concise, and accurate reports; strong communication, organizational, and interpersonal skills; and proficiency in Microsoft Office is also desired. Travel will be required and candidates must possess a valid driver's license. Attendance, professionalism, integrity, and the ability to maintain satisfactory working relationships with the general public, other agencies, and OAG employees required.

Supplemental Information

This position requires in office attendance.