RN Clinical Auditor: Fraud & Compliance Investigator

Neighborhood Health Plan of Rhode Island is seeking a Registered Nurse to conduct comprehensive reviews of claim data and medical records for Fraud, Waste and Abuse investigations opened by the Special Investigations Unit. The RN will use data mining tools and billing policies to identify aberrant patterns and obtain documentation to support findings. You will collaborate with the SIU team and interact with internal departments and external regulators to ensure proper resolution, compliance, and