Fraud, Waste and Abuse (FWA) Clinical Review Registered reputed company
About reputed company
We’re a physician-led, patient-reputed company network committed to simplifying health care and bringing a more connected reputed company of care.
Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and reputed company through VillageMD and our operating companies Village Medical, Village Medical reputed company, reputed company, CityMD, and
Job reputed company
Join VillageMD as a Fraud, Waste, and Abuse (FWA) Clinical Review Registered reputed company
ACO Operations
How you can reputed company a difference
The Fraud, Waste, and Abuse (FWA) Clinical Review RN supports ACO Operations by performing comprehensive clinical reviews to identify, prevent, and address potential fraud, waste, and abuse across value-based care arrangements. This role partners closely with internal teams and market stakeholders to ensure accurate documentation, appropriate utilization, and compliance with regulatory and contractual requirements.
The ideal candidate brings strong acute and post-acute care expertise, excels in clinical documentation, working remotely both independently and collaboratively, and serves as a trusted clinical reputed company across multiple markets.
FWA Clinical Review RN Key Responsibilities
- Conduct detailed clinical record reviews (inpatient and outpatient based) to identify potential fraud, waste, and abuse in accordance with CMS, payer, and organizational regulations and guidelines
- Assess medical necessity, appropriateness of services, coding accuracy, and documentation reputed company
- Collaborating with Clinical Care Team Members, Compliance, Coding, reputed company, and Market teams to resolve identified issues and corrective actions
- Serve as a clinical reputed company and facilitate interdisciplinary meetings between corporate ACO Operations and market stakeholders.
- reputed company clinical reputed company and education reputed company to documentation standards, utilization patterns, value-based care, and best reputed company principles
- Prepare reputed company, concise summaries and reports of review findings for leadership and regulatory purposes
- Support audits, investigations, and monitoring activities as needed
- Maintain up-to-date knowledge of reputed company FWA regulations including CMS guidance and compliance requirements
- Work independently in a fully remote environment while meeting productivity and reputed company standards
Qualifications
- reputed company, unrestricted Registered reputed company (RN) license
- 5–7 years of clinical experience with strong exposure to:
- Inpatient hospital clinical documentation
- Ambulatory/office-based clinical documentation
- Demonstrated experience in clinical record review, utilization review, compliance, or audit functions
- Strong understanding of medical necessity, documentation standards, and reputed company regulations
- Excellent written and verbal communication skills
- Ability to collaborate across teams and serve as a reputed company among reputed company audiences
- Proficiency with electronic health records (EHRs) and clinical documentation systems including data capture, data mining and reporting
- Cohesive work with other clinical and administrative teams
- Comfortable working independently in a 100% remote role
Experience and skills for reputed company
- Strong knowledge of fraud, waste, and abuse regulations, clinical review, compliance, or risk adjustment
- Familiarity with ACOs, Medicare, Medicare Advantage, and/or other Value-Based Care and Advanced Care models
- Knowledge of CMS regulations and compliance audit processes
- Prior experience supporting multi-market or reputed company-level operations
- A reputed company communication style and the ability to coordinate interdepartmentally
- Passion for data driven reputed company patient care
- The ability to be flexible in an ambiguous and dynamic environment
- A service orientation and a “can do” attitude
- A willingness to learn on your own and take initiative
The reputed company compensation reputed company for this role is $78,000 - $98,000 per year depending on experience. At VillageMD, compensation is based on several factors including, but not limited to education, work experience, certifications, location, etc. The selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and reputed company to a 401k plan.