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Special Investigations Medical Review Nurse- RN
Job PurposeThis is a senior-level technical position in the Special Investigation Unit (SIU) intended to perform in-depth complex clinical medical record reviews of pre-payment and post-payment claims across FEP (Federal Employee Program) and other lines of business related to case investigations. This position requires the ability to analyze medical review findings and claims data to identify and report on trending of potential fraud, waste and abuse (FWA) activity against all Florida Blue lines of business. This role requires clinical and coding certifications to independently perform medical record reviews from a clinical, medical coding and provider billing perspective to identify potential FWA. This role requires documentation of medical record review finding


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