2 days old

Medical Review RN Manager - Healthcare Fraud

Jacksonville, FL 32202
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Business Group Highlights

Risk Decision

The Risk Decision group is a mission-critical provider of specialized investigative services to a broad range of organizations spanning the federal, intelligence and civilian sectors. Leveraging a nationwide footprint of highly experienced investigators and subject matter experts, we provide critical information to support sensitive decisions.

Responsibilities

Every day at Perspecta, we enable hundreds of thousands of people to take on our nation's most important work. We're a company founded on a diverse set of capabilities and skills, bound together by a single promise: we never stop solving our nation's most complex challenges. Our team of engineers, analysts, developers, investigators, integrators and architects work tirelessly to create innovative solutions. We continually push ourselves to respond, to adapt, to go further. To look ahead to the changing landscape and develop new and innovative ways to serve our customers.

Perspecta works with U.S. government customers in defense, intelligence, civilian, health care, and state and local markets. Our high-caliber employees are rewarded in many ways not only through competitive salaries and benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter.

Perspecta's talented and robust workforce 14,000 strong'stands ready to welcome you to the team. Let's make an impact together.

SafeGuard Services (SGS), a subsidiary of Enterprise Services, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

Since 1999, SGS has prevented more than $9.1 billion in inappropriate payments, consisting of over $5.7 billion in proactively Prevented Dollars and $3.4 billion in Recovered Dollars. Our experience with fraud and abuse analytics has resulted in the referral of hundreds of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.

Position Overview:
This position entails providing direction to identify and research issues of potential fraud, waste and abuse. Primary responsibilities include oversight and assistance to the development of cases for referral to law enforcement or other entities and responding to requests for data and support for existing casework.

Essential Functions:

Ability to establish goals, objectives and plans for the unit

Ability to motivate staff and evaluate performance

Ability to plan resources to address workload needs, set priorities and report unit activity

Ability to develop, administer, and control a budget

Ability to administer compensation and other corporate polices

Ability to recruit and develop staff

Ability to effectively work independently and as a member of a team

Qualifications

Education and Experience required:

Must be a US Citizen or Green Card Holder

An active Registered Nurse license is required with a bachelor's degree in nursing is required.

Six years of professional experience with an active Registered Nurse license with a minimum of three years supervisory experience in the general area of medical/ utilization review. Individual must demonstrate experience and knowledge with health care coding.

Must have proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste and abuse.

Must have knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program.

Requires excellent organizational and communications skills as well as strong PC skills.

About Perspecta

What matters to our nation, is what matters to us. At Perspecta, everything we do, from conducting innovative research to cultivating strong relationships, supports one imperative: ensuring that your work succeeds. Our company was formed to bring a broad array of capabilities to all parts of the public sectorfrom investigative services and IT strategy to systems work and next-generation engineering.

Our promise is simple: never stop solving our nations most complex challenges. And with a workforce of approximately 14,000, more than 48 percent of which is cleared, we have been trusted to just that, as a partner of choice across the entire sector.

Perspecta is an AA/EEO Employer - Minorities/Women/Veterans/Disabled and other protected categories.

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As a government contractor, Perspecta abides by the following provision
PAY TRANSPARENCY NONDISCRIMINATION PROVISION
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Industry

  • Information Technology
Posted: 2019-11-09 Expires: 2019-12-08

With offerings in mission services, digital transformation and enterprise operations, our team of 14,000 engineers, analysts, investigators and architects work tirelessly to create innovative solutions. We have the expertise and experience not only to devise solutions, but to execute on them successfully.

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Medical Review RN Manager - Healthcare Fraud

Perspecta
Jacksonville, FL 32202

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