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Job Title:  COMPLIANCE SPECIALIST - RN

COMPLIANCE SPECIALIST - RN - 60014416
Posting Close Date:  N/A
Location: 

CARSON CITY, NEVADA, US, 89703

Requisition Id:  643

Department: DEPARTMENT OF BUSINESS AND INDUSTRY

Division: B&I - INDUSTRIAL RELATIONS DIV 

Business Unit: HR-INDUSTRIAL RELATIONS 

Work Type: PERMANENT 

Salary Range: $55,958.40 - $83,394.72

 

Recruiter: LISA D FRIEND 

Phone:  775 684-0110 

Email: friend@admin.nv.gov 

 

 

Position Description

The Compliance Specialist-Registered Nurse provides medical expertise for the Division of Industrial Relations, Workers' Compensation Section-Southern region.  The incumbent monitors compliance and detects violations of State Laws and /or regulations by medical providers, insurance carriers, Third Party Administrators (TPAs), medical billing vendors, employers, and in Permanent Partial Disability (PPD) reports; supervises Compliance/Audit Investigators and oversees the Medical Unit in their assigned region; verifies medical providers and claim file records have appropriate documentation and ensures authorized services correlate with services provided; reviews medical records; conducts interviews with insurance carriers, TPAs, medical providers, employers and injured employees; documents findings and deficiencies on appropriate forms; makes determinations regarding program violations; gathers data and revises the regulation of fees and charges pertaining to the Nevada Medical Fee Schedule; provides advice and assistance in the preparation of medical documentation and testimony for hearings and appeals; and ensures compliance with standards of health care.  

 

The incumbent will train internal and external staff and Panel of Treating and Rating Physicians and Chiropractors; investigate and recommend warning, suspending or removing provider from the panel of treating physicians and chiropractors when disciplinary action is imposed by the licensing board; verify providers and fiscal agents are in compliance with division policies and procedures; conduct periodic audits; review and identify potential errors and refer PPD reports to Quality Assurance (QA) Panel to provide opinions; facilitate QA Panel meetings; review records from providers and claim files to identify potential fraud and ensure claims were paid properly; explain proper billing procedures to providers; refer payment errors to TPAs or insurance carrier for adjustment of charges and refer potential cases of fraud and abuse for further investigation; and performs related duties as assigned.

 

To see full Class Specifications visit: http://hr.nv.gov/Resources/ClassSpecs/Class_Specifications-10_0//

 

***THIS RECRUITMENT MAY CLOSE AT ANY TIME BASED ON THE AMOUNT OF APPLICATIONS RECEIVED. QUALIFIED APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE.***

Minimum Qualifications

  • Current license to practice as a Registered Nurse and two years of professional nursing experience, one year of which included professional experience in workers' compensation, occupational health, or case management; OR an equivalent combination of education and experience.

 

The Examination

Application Evaluation Exam

  • The exam will consist of an application evaluation. It is essential that applications include detailed information with time frames regarding education and experience. The most qualified applicants will be contacted by the hiring agency for interview. The hiring agency may require specific skills related testing as part of the interviewing process.

 

Special Requirements

  • A valid driver's license is required at the time of appointment and as a condition of continuing employment.
  • Ability to perform public speaking activities
  • A Bachelor's degree from an approved school of professional nursing, pursuant to NRS 632, is equivalent to a bachelor's degree from an accredited college or university.

 

The State of Nevada is committed to Equal Employment Opportunity/Affirmative Action in recruitment of its employees and does not discriminate on the basis of race, color, national origin, religion or belief, age, disability, sex, sexual orientation, gender identity or expression, pregnancy, domestic partnership, genetic information (GINA), or compensation and/or wages.


Nearest Major Market: Carson City
Nearest Secondary Market: Reno