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Qlarant

Nurse Specialist II

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple ...

New

The Family Tree Concept Inc

Direct Support Contractor

Miami, FL · On-site

$14.25 - $17.50/hr

Documentation & Medicaid/FCC Compliance The Contractor must complete Qlarant-compliant service logs including: · Person served · Service type · Date · Time in/out · Location · Detailed ...

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$8

$26

$61

How much do qlarant jobs pay per hour?

As of Aug 5, 2026, the average hourly pay for qlarant in the United States is $26.34, according to ZipRecruiter salary data. Most workers in this role earn between $15.14 and $30.77 per hour, depending on experience, location, and employer.

What is Qlarant?

Qlarant is a company that specializes in quality improvement, program integrity, and technology solutions, particularly within the healthcare and government sectors. They provide services such as fraud, waste, and abuse detection, data analysis, and quality review to help organizations improve outcomes and ensure compliance. Qlarant works with federal, state, and private clients to support program integrity and enhance operational efficiency.

What are the key skills and qualifications needed to thrive as a Qlarant employee, and why are they important?

To thrive as a Qlarant employee, you generally need expertise in healthcare quality assurance, data analysis, and regulatory compliance, often supported by relevant degrees or certifications such as RN, CPC, or PMP. Familiarity with analytics software, healthcare databases, and quality improvement tools like CMS systems is important. Strong attention to detail, critical thinking, and collaborative communication are essential soft skills in this role. These competencies enable employees to ensure compliance, drive quality improvement, and deliver impactful results in healthcare environments.

What types of projects do team members typically work on at Qlarant, and how is collaboration fostered within the company?

At Qlarant, team members are often involved in projects related to healthcare quality improvement, data analysis, and program integrity. Employees frequently collaborate across departments such as data analytics, clinical review, and project management to deliver client-focused solutions. The company encourages open communication through regular team meetings and cross-functional initiatives, ensuring that staff can share expertise and learn from one another. This collaborative work environment helps employees develop professionally while contributing to impactful, mission-driven projects.
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Qlarant jobs near you
Infographic showing various Qlarant job openings in the United States as of July 2026, with employment types broken down into 80% Full Time, and 20% Contract. Highlights an 100% Physical job distribution, with an average salary of $54,791 per year, or $26.3 per hour.

Nurse Specialist II

Qlarant

Remote

Other

Posted 2 days ago

New

Job description

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.
Best People, Best Solutions, Best Results
Job Summary:
Performs medical record and claims review for Medicare, Medicaid, and/or other claims data in order to ensure that proper guidelines have been followed and assesses for potential overpayment, fraud, waste, and abuse with regards to Medicare, Medicaid, and/or other claims.
Essential Functions:

  • Reviews beneficiary, provider, and/or pharmacy cases for potential overpayment, fraud, waste, and abuse.
  • Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
  • Consults with benefit integrity investigation experts and pharmacists for advice and clarification.
  • Completes case summaries and provides results to investigators to support the investigative process.
  • Provides case specific or plan specific data entry and reporting.
  • Participates in internal and external focus groups, as required.
  • Participates in provider onsite visits and beneficiary interviews, as required, for field audits/investigations.
  • Testifies at various legal proceedings, as necessary.
  • Provides job-specific orientation and training, as needed. Helps develop training content, resources, and programs specific to job functions.

Level of Supervision Received:
Plans and arranges own work; works with manager to prioritize projects
Education (can be substituted for experience):
Minimum Bachelor's Degree required
Work Experience (can be substituted for education):
2 - 4 years of experience required; 5 - 7 years preferred
Medical claims review experience required
Experience and knowledge of Medicare/Medicaid preferred
Certification(s):
Current, active and non-restricted RN licensure required
Coding certification preferred
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.
Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.

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