Nurse Analyst (Health Professional III)

The Colorado Department of Law, Consumer Protection Section, is seeking an experienced Nurse Analyst to join the Medicaid Fraud Control Unit! The Office of the Attorney General offers the opportunity to be involved in challenging, interesting, and meaningful work in a collaborative environment. The Medicaid Fraud Control Unit investigates cases that directly impact the lives of Coloradans and ensures that Coloradans have access to the highest quality of care from dedicated providers, while continuing to reduce Medicaid fraud and patient abuse across the state. If you are interested in learning more about the Office of the Attorney General and providing meaningful services to Colorado’s citizens, apply today!

WHAT YOU WILL DO
The Colorado Medicaid Fraud Control Unit (COMFCU) maintains a strong commitment to ensuring that Coloradans have access to the highest quality of care from dedicated providers while continuing to take an aggressive approach to reducing Medicaid fraud and patient abuse across the state.

The dual missions of the COMFCU are:

• To protect the state and federal funds dedicated to providing health care and medical services to Colorado Medicaid beneficiaries.
• To hold individuals accountable for the abuse, neglect, or financial exploitation of clients in board and care facilities as well as those in facilities that accept Medicaid dollars.

The Nurse Analyst will assist in the investigation and prosecution of cases involving the abuse, neglect, and financial exploitation of vulnerable adults. This position requires the Nurse Analyst to investigate allegations regarding potential crimes both independently and as part of an investigative team to assist investigators and attorneys in the unit by providing nursing expertise in analyzing medical records and charts, assessing standards of care and fraud. This role also provides the opportunity to conduct outreach with other state agencies and stakeholders in the community on abuse, neglect, and financial exploitation issues and the mission of the Medicaid Fraud Control Unit.

Responsibilities include:

• Collaborate with Unit investigators and attorneys by providing expertise in analyzing medical records and charts and by assessing standards of care and levels of service in investigating allegations of fraud.
• Accomplish a preliminary analysis of complex medical charts from different types of medical providers, including physician offices,hospitals, and skilled nursing facilities.
• Review medical evidence and develop resuluting opinion which will assist investigators and attorneys in trial preparation.
• Assist in the preparation of cases for court including, preparing for medical experts, analyzing medical records and producing related trial exhibits.
• On rare occasions, testify in court as to findings.
• Engage in community outreach to educate state agencies and advocacy groups about Medicaid fraud, abuse and neglect.

WHAT WE ARE LOOKING FOR
 
Minimum Qualifications and Substitutions: Please document all relevant experience in detail on your application. Experience will not be inferred or assumed. Any part-time experience listed will be prorated. 

• 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
• Two (2) years (full-time equivalent) professional clinical experience as a Registered Nurse or Nurse Practitioner.

• Health care law, rules, and policies
• Medicaid or Medicare regulations and statutes
• Elder or patient abuse issues
• Nursing homes an/or long-term care environments
• Conducting public outreach
• Working with individuals that have developmental or intellectual disabilities

Required Competencies:

• Requires proficiency with MS Office Suite

Note: Candidates possessing a foreign degree must submit a translation (evaluation) of their degree from an accredited institution, such as The National Association of Credential Evaluations Services in order to be given credit for the degree.

Conditions of Employment: 

• The final candidates for employment must successfully pass a thorough criminal background investigation.
• This position will be required to travel frequently and may include overnight travel within the State of Colorado.

View the full job announcement for more information, including information about benefits and compensation, and to apply online.