Nurse Investigator

As a Medicaid Nurse Investigator, you will be responsible for investigating potential cases of fraud, waste, and abuse within the Medicaid program. Working closely with state agencies, healthcare providers, and other stakeholders, you will conduct thorough reviews and analyses of medical records, claims data, and other pertinent information to identify irregularities and potential instances of wrongdoing. Your findings will contribute to the prevention and detection of fraudulent activities, ultimately safeguarding the integrity of the Medicaid system.
Note: as of April 8, 2024, OIG employees will be working a hybrid schedule, which includes 2 office days per week and 3 telework days.
Why work for the Utah Department of Government Operations? In addition to the rich benefits the State of Utah offers, the Cannon Health Building offers:

• On-site fitness center, for a minimal membership fee
• UTA Eco Pass, at a discounted monthly rate
• Teleworking opportunities with a minimum 2 office days per week beginning 04/2024.
• On-site day care center at the Cannon Health Building with First Steps Day Care - contact for rates and availability, 801-538-6996

Example of Duties

• Analyzes, summarizes and/or reviews data; reports findings, interprets results and/or makes recommendations.
• Reviews and/or inspects work for quality, accuracy, and completeness.
• Ensures compliance with applicable federal and/or state laws, regulations, and/or agency rules, standards and guidelines, etc.
• Decides upon the need for
• Enters data into a computer system and retrieves, corrects, or deletes previously entered data.
• Writes or drafts correspondence, reports, documents and/or other written materials.
• Provides information concerning rights, options, benefits, services, goals and expectations.
• Receives, researches and responds to incoming questions or complaints; provides information, explains policy and procedures, and/or facilitates a resolution.

Typical Qualifications

• use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions
• conduct a methodical examination
• speak clearly, concisely and effectively; listen to, and understand information and ideas as presented verbally
• communicate information and ideas clearly and concisely in writing, read and understand information presented in writing
• establish and maintain effective working relationships with employees, management, representatives of other agencies, and the public
• research methods, techniques, and/or sources of information
• interviewing techniques
• work independently with little or no supervision
• use computer word processing software
• use computer spreadsheet software
• use automated software applications
• applicable laws, rules, regulations and/or policies and procedures

Supplemental Information

• Best qualified individuals would generally have obtained a BSN.
• Licensure as a registered nurse (RN) in the state of Utah.
• Effective July 1, 2021, State of Utah Employees must either reside in Utah or be in the process of relocating to within 30 days of their start date.
• This position may currently be a hybrid of both in-office and remote work days. Please note, a position's eligibility for remote work is established by agency management and is subject to change at their discretion, at any time and for any reason.
• Risks found in the typical office setting, which is adequately lighted, heated and ventilated, e.g. safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
• Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc.