Fraud, Waste and Abuse; FWA Clinical Review Registered Nurse

Position: Fraud, Waste and Abuse (FWA) Clinical Review Registered Nurse
Location: New York

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** About Our Company
** We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through Village

MD and our operating companies , , , , and .When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.
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* Please Note:

** We will only contact candidates regarding your applications from one of the following domains: , , , , , , or  
** Job Description
**** Join Village

MD as a*
* ** Fraud, Waste, and Abuse (FWA) Clinical Review Registered Nurse*
* ** ACO Operations
**** How you can make 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 liaison 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 integrity
* Collaborating with Clinical Care Team Members, Compliance, Coding, Quality, and Market teams to resolve identified issues and corrective actions
* Serve as a clinical liaison and facilitate interdisciplinary meetings between corporate ACO Operations and market stakeholders.
* Provide clinical insight and education related to documentation standards, utilization patterns, value-based care, and best practice principles
* Prepare clear, 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 all FWA regulations including CMS guidance and compliance requirements
* Work independently in a fully remote environment while meeting productivity and quality standards
** Qualifications
* ** Active, unrestricted Registered Nurse (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 healthcare regulations
* Excellent written and verbal communication skills
* Ability to collaborate across teams and serve as a liaison among all 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 success
*** 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 enterprise-level operations
* A collaborative communication style and the ability to coordinate interdepartmentally
* Passion for data driven quality patient care
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