Clinical Nurse Investigator, SIU 100% Remote
Clinical Nurse Investigator, SIU Location: Remote Experience Level: Intermediate
Overview
We are seeking detail‑oriented and clinically strong Registered Nurses (RNs) or Licensed Vocational/Practical Nurses (LVNs/LPNs) to join our client’s Special Investigative Unit (SIU) as Clinical Quality Assurance Coordinators . In this role, you will support the review of medical services, validate accuracy, and ensure compliance with policies, criteria, and fraud‑waste‑abuse (FWA) standards. You will partner closely with Client Coordinators who process applications and referrals, then rely on you to complete the clinical quality review and communicate findings back to clients.
Key Responsibilities
- Conduct detailed quality assurance reviews of processed referrals and applications.
- Verify accuracy of surgeon selection, specialty alignment, and State Insurance usage.
- Confirm that requested services were completed exactly as ordered—no more, no less.
- Assess whether services met clinical policies, criteria, and medical necessity.
- Identify irregularities such as upcoding, unbundling, incorrect modifier usage, or unusual billing patterns.
- Prepare clear, grammatically accurate reports summarizing findings and clinical rationale.
- Communicate results to clients via phone and email with professionalism and clarity.
- Manage quick‑turnaround cases and prioritize workload effectively.
SIU Division Requirements
- Experience in Group Health SIU or similar investigative environments.
- Strong understanding of Fraud, Waste, and Abuse (FWA) detection and investigative methods.
- Solid working knowledge of CPT, HCPCS, ICD‑10 codes and billing/payment policies.
- Ability to identify clinical and billing irregularities with precision.
Required Skills
- Quality assurance and clinical analysis
- Nursing documentation software
- Understanding of insurance policies and clinical documentation
- Strong written and verbal communication
- Ability to interpret clinical information and apply criteria accurately
Job Type & Location This is a Contract to Hire position based out of Atlanta, GA. Pay And Benefits The pay range for this position is $24.00 - $29.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Mar 17, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems And TEKsystems Global Services We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. Apply tot his job Apply To this Job