HMS Career Opportunities
Within the last 5 years, what role did the following play in your job:
Medicaid program integrity experience
Do you have an active Registered Nurse license in North Carolina?
Do you have at least three years of experience in post payment reviews or clinical audits?
Please note that this position is no longer available.
If you would like to be considered for similar opportunities now or in the future, feel free to apply and/or set up a notifier for yourself.
Clinical Review Supervisor
NC - Raleigh
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Opportunity Snapshot

If you are passionate about Medicaid program integrity, this company and role is your "dream job". Quick question for you - click here It might seem like overstatement, but consider the facts: If you are ready to take your career to the next level, we look forward to hearing from you.

Our Requirements

Preferred, but not required:

More About Your Role

The scope of the Clinical Review supervisorAudit MIC work is identifying overpayments of Medicaid providers through Medical Review, and the audit team you will supervise will be reviewing medical records and comparing the claims to both the Medical Records and the Medicaid policy governing specific types of services Quick question for you - click here.

Your mission as the Clinical ReviewAudit Supervisor will be to oversee the audit process, maintain the project database, obtain medical records from provider sites and create and deliver project related reports.

The Nurse Reviewers will conduct post payment reviews to determine fraud, waste and abuse.  This will include on-site retrospective hospital reviews of all at 66 hospital systems using nationally accepted clinical criteria.  Reviews will also be performed for other provider types such as physicians, home health agencies and DME companies. You will have the ability to expertly manage this function.

You will have the ability to train and develop your team into a high performing group.  You will perform quality assurance reviews to ensure timely deliverables are met.  You will work closely with the Medical Director and physician reviewers during the reviews and when writing determination letters and making presentations.   You will be our ambassador for knowledge of the project, community relations and maintaining high levels of customer service. 

The HMS leadership team recognizes the strategic importance of thise CMS initiative, and as a result you will have access to the resources you need to make it a success, such as additional staff. You'll find our environment refreshing in its lack of bureaucracy and "red tape.".

Who We Are

HMS Holdings Corp. (HMS) is the leader in coordination of benefits and program integrity services for government healthcare programs. The company's clients include health and human services programs in more than 40 states, over 90 Medicaid managed care plans, the Centers for Medicare and Medicaid Services (CMS), and Veterans Administration facilities. HMS helps ensure that healthcare claims are paid correctly and by the responsible party. As a result of the company's services, government healthcare programs recover over $1 billion annually, and avoid billions of dollars more in erroneous payments.

We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.

Opportunity Snapshot

If you are passionate about Medicaid program integrity, this company and role is your "dream job". Quick question for you - click here It might seem like overstatement, but consider the facts: If you are ready to take your career to the next level, we look forward to hearing from you.

Our Requirements

Preferred, but not required:

More About Your Role

The scope of the Clinical Review supervisorAudit MIC work is identifying overpayments of Medicaid providers through Medical Review, and the audit team you will supervise will be reviewing medical records and comparing the claims to both the Medical Records and the Medicaid policy governing specific types of services Quick question for you - click here.

Your mission as the Clinical ReviewAudit Supervisor will be to oversee the audit process, maintain the project database, obtain medical records from provider sites and create and deliver project related reports.

The Nurse Reviewers will conduct post payment reviews to determine fraud, waste and abuse.  This will include on-site retrospective hospital reviews of all at 66 hospital systems using nationally accepted clinical criteria.  Reviews will also be performed for other provider types such as physicians, home health agencies and DME companies. You will have the ability to expertly manage this function.

You will have the ability to train and develop your team into a high performing group.  You will perform quality assurance reviews to ensure timely deliverables are met.  You will work closely with the Medical Director and physician reviewers during the reviews and when writing determination letters and making presentations.   You will be our ambassador for knowledge of the project, community relations and maintaining high levels of customer service. 

The HMS leadership team recognizes the strategic importance of thise CMS initiative, and as a result you will have access to the resources you need to make it a success, such as additional staff. You'll find our environment refreshing in its lack of bureaucracy and "red tape.".

Who We Are

HMS Holdings Corp. (HMS) is the leader in coordination of benefits and program integrity services for government healthcare programs. The company's clients include health and human services programs in more than 40 states, over 90 Medicaid managed care plans, the Centers for Medicare and Medicaid Services (CMS), and Veterans Administration facilities. HMS helps ensure that healthcare claims are paid correctly and by the responsible party. As a result of the company's services, government healthcare programs recover over $1 billion annually, and avoid billions of dollars more in erroneous payments.

We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.

HMS is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
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