Nurse Specialist II
Performs medical record and claims reviews to identify potential fraud, waste, and abuse within Medicare and Medicaid programs. Conducts desk reviews, field audits, and provides case summaries to support investigative processes.
Qlarant
Remote Job Openings at Qlarant (5)
Manager - Program Integrity
The Manager of Program Integrity oversees the performance of the division, monitors metrics, and leads investigative teams to identify and mitigate fraud, waste, and abuse. They also serve as a liaison with government agencies and stakeholders to ensure compliance and operational efficiency.
Nurse Specialist II
Review medical records, claims, and beneficiary, provider, or pharmacy cases to identify potential overpayments, fraud, waste, and abuse, including through desk reviews and field audits. Prepare case summaries and reports, support investigations, consult with specialists, participate in interviews and onsite visits, testify when needed, and contribute to training.
Quality Review Specialist III
Facilitates routine evaluations to assess the quality of support and services provided to individuals with intellectual and developmental disabilities. Collaborates with service providers to implement continuous improvements and ensures compliance with relevant laws and safety standards.
Data Surveyor – Intellectual and Developmental Disabilities- IDD
Surveyors are responsible for conducting in-person, telephonic, and virtual NCI surveys with individuals receiving HCBS services. They must document responses accurately, maintain participant privacy, and report findings to the project team.