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Nurse Investigator

Nebraska Attorney General's Office - Lincoln, NE
Posted on: September 05, 2023

Contact Info
Dana Hoffman
[email protected]
(402) 471-2687

The Medicaid Fraud and Patient Abuse Unit of the Nebraska Attorney General’s Office is seeking qualified applicants for a Nurse Investigator.
DISTINGUISHING CHARACTERISTICS OF WORK

The Nurse Investigator will assist in the investigation and prosecution of cases involving fraud against the Medicaid system and the abuse, neglect, and financial exploitation of vulnerable adults. This position requires the Nurse Investigator to investigate allegations regarding potential crimes both independently and as part of an investigative team. The successful applicant will assist investigators and attorneys in the unit by providing nursing expertise in analyzing medical records and charts, assessing standards of care and analysis of potential fraud. They will also assist with interviews of medical personnel; provide consultation on medical issues and long-term care issues, and review complaints filed with the Nebraska Office of Adult Protective Services. This role also provides the opportunity to conduct outreach with other state agencies and stakeholders in the community on fraud, abuse, neglect, and financial exploitation issues and the mission of the Medicaid Fraud and Patient Abuse Unit.
Work is performed under the general direction of the Chief Investigator and the Unit Director.
The Nebraska Department of Justice is dedicated to assuring equal employment opportunity to applicants and employees in all aspects of personnel administration without regard to political affiliation, race, color, national origin, sex, age, marital status, mental or physical disability, or religious creed and with proper regard for their privacy and constitutional rights. Veterans’ preference applicable.
RESPONSIBILITIES INCLUDE:
Review complaints received from various government agencies and the public to identify cases of fraud and/or abuse, neglect or exploitation requiring further investigation.
Procure, analyze and interpret electronic data, financial records, medical records, investigative records, legal documents, federal and state laws, regulations, policies and other material in the pursuit of evidence of fraud, abuse, neglect or exploitation.
Collaborate with Unit investigators and attorneys by providing expertise in analyzing medical records and charts from various types of Medicaid providers, making determinations of medical necessity, determining whether services were provided and properly documented, determining whether proper diagnostic and procedure codes were used in submitting claims to Nebraska Medicaid and by assessing standards of care and levels of service in investigating allegations of fraud, abuse, neglect or exploitation.
Develop accurate detailed reports of investigative findings with recommendations, with appropriate justification, for civil, criminal, or administrative action.
Locate, interview and write reports on information gathered from potential witnesses and suspects, including Medicaid providers, their employees, recipients, and others who may have knowledge pertinent to evaluating whether Medicaid providers have violated state and federal laws.
Testify as necessary in court proceedings resulting from investigations.
MINIMUM QUALIFICATIONS:
Bachelor’s degree from an accredited college or university in nursing, biology, chemistry, psychology, public health, criminology, criminal justice, or a field of study closely related to the work assignment, and
Minimum of two (2) years professional clinical experience as a Registered Nurse or Nurse Practitioner.
Must possess and maintain all appropriate professional licenses through the State of Nebraska.
PREFERRED QUALIFICATIONS AND EXPERIENCE:
Proficient in chart review, clinical record information systems, and coding methodologies.
Health care law, rules, and policies
Medicaid or Medicare regulations and statutes
Elder or patient abuse issues
Nursing homes and/or long-term care environments
Working with individuals that have developmental or intellectual disabilities
Proficient in MS Office Suite applications.
APPLICATION:
Please email the following: to:

Nebraska Attorney General's Office
Email [email protected]
• Cover letter with a summary that clearly explains how the applicant’s work experience is related to the work characteristics and responsibilities for the position.
• Resume, including professional references.
• A copy of your current nursing license(s).
• College transcript (unofficial copy is acceptable) if you have less than 10 years experience in nursing.



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*When seeking employment, please be aware that some organizations have a tobacco-free/nicotine-free environment policy in effect both inside and outside of their facilities, and will only hire tobacco free/nicotine free candidates. You may be required to complete nicotine testing, as part of the hiring process, and these results may make you ineligible for employment.