MEDICAL SERVICES REVIEWING NURSE SUPERVISOR

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DHMH, Office of  The Inspector General, Baltimore, MD

The main purpose of this position is to provide supervision for clinicians within the Office of the Inspector General. (OIG) The incumbent will supervise efforts of the clinicians to identify fraud,waste,and abuse by healthcare providers within the Maryland Medicaid Program and recovery of all funds identified as paid not in accordance with State and Federal regulations. The incumbent will consult and advise OIG data specialists in creating data runs to identify anomalies within the Medicaid Program's claim. The incumbent will utilize specialized nursing knowledge and extensive experience in Current Procedural Terminology coding, Internal Classification of Disease coding, and Healthcare Common Procedure Coding and general billing experience. Also, the incumbent will be responsible for on-site desk reviews of medical records, providing education to Medicaid providers,and providing administrative oversight for OIG clinical staff. Knowledge and experience in nursing and supervision, as well as knowledge of State and federal regulations is essential in order to make definitive decisions pertaining to regulatory compliance.

Education: Possession of a Bachelor's degree in Nursing or a related field from an accredited college or university.

Experience: Two years of experience reviewing medical services claims to ensure that the nature and quality of services are in accordance with State and federal regulations.

Note: 

1. Two years of experience as a Registered Nurse may be substituted for the required education.

2. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Nursing classifications or Nursing  specialty codes in the Nursing field of work on a year-for-year basis for the required education.

The applicant must have at least 2 years experience in coding of healthcare claims or in conducting medical records reviews.

The incumbent should be able to review Medicaid claims, medical records and assist in conducting both on-site and desk reviews of medical records. The incumbent should have experience in investigating health care fraud and or identifying aberrant billing errors; auditing medical records; and/or coding claims for submission to Medicaid, Medicare or private insurance. The incumbent should have a working knowledge of Microsoft applications, programs and frequently used search engines. The incumbent should have supervisory experience.

1. Candidates for positions in this classification must possess a current license as a Registered Nurse from the Maryland State Board of Nursing, 4140 Patterson Avenue, Baltimore, Maryland 21215.  A copy of your current license or license verification should accompany your application.

2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.

Applicants who meet the minimum qualifications will be evaluated.  The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.  Therefore, it is essential that you provide complete and accurate information on your application.  Please report all related education, experience, dates and hours of work.  For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service must accompany the application.  All information concerning your qualifications must be submitted by the closing date.  We will not consider information submitted after this date.  Applicants certified to list will receive eligibility for a period of one (1) year.  Eligibility may be extended beyond one (1) year period.

Online applications are highly recommended, however the paper application may be submitted to DHMH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.  The paper application must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

Incorrect application forms will not be accepted.

If you need to submit additional information, the preferred method is to upload.  If unable to upload, please fax requested information only to 410-333-5689.

Should additional information regarding this recruitment be required, please contact the DHMH Recruitment and Selection Division at 410-767-1251 or via email at dhmh.jobs@maryland.gov. 

Appropriate accommodations for individuals with disabilities are available upon request by calling: (410) 767-1251 or MD TTY Relay Service 1-800-735-2258.

STATE OF MARYLAND BENEFITS

As an equal opportunity employer, Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.

The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

We thank our Veterans for their service to our country, and encourage them to apply.

Bilingual applicants are encouraged to apply.