Medical Services Consultant-Nurse: ACS (Affiliated Computer Services)

PURPOSE OF POSITION:

The SUR Nurse Analyst is responsible for researching provider activity to detect fraud, abuse, and waste.

RESPONSIBILITIES:

1.                   Reviews and assess utilization patterns of healthcare providers.

2.                   Performs quarterly retrospective review on identified Medicaid providers.

3.                   Performs and/or monitors provider recoupment activities as required.

4.                   Performs medical record reviews as directed.

5.                   Evaluates and validates the SUR reports.

6.                   Reads and interprets data and makes recommendations based on analysis.

7.                   Assists with provider education through teleconference and written communication.

8.                   Attends internal and external meetings as directed.

9.                   Ability to exercise discretion and independent judgment.

10.               Performs other duties as assigned.

Education and Typical Years Experience

Registered Nurse with a minimum of three years general nursing experience

Bachelor’s degree in health or human services field including but not limited to: Nursing, Social Work, Sociology, Special Education, Rehabilitation Counseling, or Psychology

All other duties as assigned.



ACS is an Equal Opportunity Employer and does not Discriminate against any applicant on the basis of race, color, religion/creed, national origin, gender, or sex, marital status, age, disability, use of a guide dog or service animal, sexual orientation, military/veteran status, or any other status protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with ACS may request such accommodations by calling 866-419-2226 .