RN Fraud Waste & Abuse Investigator

Location: Remote (Must Reside in Southern California & Hold CA RN License)
Schedule: Monday – Friday, 8:00 AM – 5:00 PM (PST)
Pay Rate: $45.99 per hour
Employment Type: Temp-to-Hire

Job Summary:

Our client, a leading healthcare organization, is seeking a California-licensed Registered Nurse (RN) to join their Special Investigations Unit (SIU). This role focuses on fraud, waste, and abuse (FWA) investigations, reviewing CLIA certification documentation from non-participating laboratories, and ensuring compliance with state and federal healthcare regulations.

This is a remote position, but candidates must reside in Southern California and be available for on-site laboratory inspections as needed.

Key Responsibilities:

✅ Review & Verify CLIA Certification Documentation – Assess non-participating laboratory compliance with certification standards.
✅ Conduct Investigations & Report Findings – Identify and report suspected fraud, waste, and abuse cases to SIU leadership.
✅ Member & Provider Outreach – Contact health plan members and non-participating labs to collect necessary documentation.
✅ On-Site Inspections – Travel within California to audit non-par laboratories and ensure proper equipment and compliance.
✅ Support SIU Referrals – Assist with other fraud investigations related to healthcare compliance.
✅ Regulatory Compliance & Reporting – Ensure documentation aligns with state and federal healthcare guidelines.

Minimum Qualifications:

✔ Active, unrestricted RN license in California (REQUIRED).
✔ Currently residing in Southern California (REQUIRED).
✔ 5 years of clinical experience (Preferred in hospice, case management, compliance, or regulatory roles).
✔ Experience in fraud, waste, and abuse investigations (Preferred but not required).
✔ Strong knowledge of CLIA certification & healthcare compliance standards (Preferred).
✔ Ability to travel for on-site inspections (as needed, frequency TBD).
✔ Proficiency in medical documentation, reporting, and compliance auditing.

Preferred Skills & Experience:

Hospice or case management experience.
Background in regulatory compliance, SIU, or healthcare investigations.
Experience in process improvement & patient safety initiatives.
Familiarity with electronic medical records (EMR) and healthcare fraud prevention strategies.