Nursing Consultant Position in Medicaid Integrity

6 days ago


Tallahassee, Florida, United States State of Florida Full time
Job Overview

This is a highly responsible professional and clinical position within the State of Florida's Bureau of Medicaid Program Integrity. As a Registered Nursing Consultant, you will play a critical role in providing medical consultation and technical assistance to investigators, auditors, analysts, and administrators.

The selected candidate will assist in various operational, administrative, and clinical functions, including serving as a consultant to the management team on clinically related topics and special projects. You will utilize your clinical knowledge and experience in interpreting medical records and comparing service documentation to submitted claims data. Additionally, you will perform medical reviews of documentation for compliance with guidelines set forth in applicable rules and Medicaid coverage and limitations policies.

The ideal candidate will have a strong understanding of nursing principles, practices, and techniques, as well as human anatomy and physiology. You will also possess excellent written and verbal communication skills and be proficient in using Microsoft Office applications. A bachelor's degree from an accredited college or university with a major in nursing can substitute for one year of the required general professional nursing experience.

Responsibilities

* Provide professional medical consultation and technical assistance to investigators, auditors, analysts, and administrators
* Serve as a consultant to the management team on clinically related topics and special projects
* Interpret medical records and compare service documentation to submitted claims data
* Perform medical reviews of documentation for compliance with guidelines set forth in applicable rules and Medicaid coverage and limitations policies

Requirements

* Licensure as a Registered Nurse or an Advanced Practice Registered Nurse in accordance with Chapter 464, Florida Statute and three years of professional nursing experience
* A bachelor's degree from an accredited college or university with a major in nursing can substitute for one year of the required general professional nursing experience

Benefits

The State of Florida offers a comprehensive benefits package, including state group insurance coverage options, flexible spending accounts, state retirement options, generous annual and sick leave benefits, and career advancement opportunities. Tuition waiver for courses offered by Florida's nationally ranked State University System and training and professional development opportunities are also available. The estimated salary for this position is $50,690.64 to $70,733.26 per year, based on the selected candidate's qualifications and experience.

This is a full-time position, budgeted for 40 hours per week, Monday-Friday 8 a.m. to 5 p.m. Travel related activities may involve up to 10% of the workweek. The selected candidate must be a Florida licensed Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN).

  • Tallahassee, Florida, United States State of Florida Full time

    Company OverviewThe State of Florida's Agency for Health Care Administration is a leading health policy and planning entity. We are responsible for administering the Florida Medicaid program, licensing and regulating nearly 50,000 healthcare facilities, and empowering consumers through healthcare transparency initiatives.Job DescriptionThis is a full-time...


  • Tallahassee, Florida, United States State of Florida Full time

    Company OverviewThe State of Florida is the chief health policy and planning entity in Florida, responsible for administering the Florida Medicaid program, licensing and regulating nearly 50,000 healthcare facilities, and empowering consumers through healthcare transparency initiatives.Job DescriptionThis is a full-time Registered Nursing Consultant position...


  • Tallahassee, Florida, United States MyFlorida Full time

    Job Summary:This is a responsible professional nursing position within the Bureau of Tobacco Free Florida, Florida Breast and Cervical Cancer Early Detection Program (FBCCEDP) section. As a Clinical Nurse Consultant, you will serve as clinical expertise and support for the FBCCEDP, reviewing and providing approval to program-related clinical cases in...


  • Tallahassee, Florida, United States MyFlorida Full time

    Job OverviewThis is a highly responsible professional and clinical position within the Agency for Health Care Administration, serving as a Registered Nursing Consultant. The selected candidate will provide expert medical consultation and technical assistance to investigators, auditors, analysts, and administrators.The position involves activities such...

  • Clinical Consultant

    5 days ago


    Tallahassee, Florida, United States MyFlorida Full time

    **Job Overview**This is a challenging and rewarding opportunity to join the Agency for Health Care Administration in Tallahassee, Florida. As a Registered Nursing Consultant, you will be working in the Bureau of Medicaid Program Integrity (MPI), providing professional medical consultation and technical assistance to investigators, auditors, analysts, and...


  • Tallahassee, Florida, United States State of Florida Full time

    We are seeking a skilled healthcare professional to join our team as a Registered Nursing Consultant in Tallahassee, Florida. This is a challenging opportunity to make a difference in the lives of individuals affected by breast and cervical cancer.Job OverviewThe successful candidate will be responsible for providing clinical expertise and support to the...


  • Tallahassee, Florida, United States Conduent State Healthcare, LLC Full time

    About the RoleAs a Customer Service Representative with Conduent State Healthcare, LLC, you will be responsible for providing exceptional customer service to Medicaid members in Kentucky. You will work in a call center environment, answering multiple types of calls and assisting members with various health benefits, including SNAP, Medicaid, and TNAF.The...


  • Tallahassee, Florida, United States Integrity Healthcare. Full time

    We are seeking a dedicated and experienced Clinical Psychologist to join our team at Integrity Healthcare as a Core Faculty Physician in Psychiatry. Located in Tallahassee, Florida, this role offers an excellent opportunity for professional growth and development in a dynamic environment.About the Role:This is a permanent position with a faculty appointment...


  • Tallahassee, Florida, United States Integrity Healthcare. Full time

    We are seeking an experienced Gastroenterologist to join our team as a Partner at Integrity Healthcare in Florida. As a key member of our medical staff, you will have the opportunity to work with a dynamic team and contribute to the growth and development of our practice.Key Highlights:Partnership track position with opportunities for advancementCompetitive...


  • Tallahassee, Florida, United States MyFlorida Full time

    About the RoleWe are seeking a highly skilled Registered Nursing Program Coordinator to join our team at MyFlorida. As a key member of our healthcare team, you will play a vital role in ensuring the success of our Breast and Cervical Cancer Early Detection Program.Job DescriptionThe Registered Nursing Program Coordinator will be responsible for reviewing and...


  • Tallahassee, Florida, United States Abacus Service Corporation Full time

    About Abacus Service CorporationAbacus Service Corporation is a dynamic and innovative organization dedicated to delivering exceptional services to its clients. We are seeking a highly skilled and motivated Senior Software Quality Assurance Consultant to join our team.OverviewThe Senior Software Quality Assurance Consultant will play a crucial role in...


  • Tallahassee, Florida, United States The Medical Healing Center Full time

    About the RoleWe are seeking a highly skilled Holistic Integrative Nurse Practitioner Specialist to join our team of healthcare professionals at The Medical Healing Center.The successful candidate will play a vital role in providing high-quality patient care, focusing on the integration of mind, body, and spirit to achieve optimal health...


  • Tallahassee, Florida, United States The Medical Healing Center Full time

    Job OverviewWe are seeking an exceptional Holistic Integrative Nurse Practitioner to join our team at The Medical Healing Center.Our practice focuses on providing primary care with an emphasis on holistic medicine, utilizing a combination of traditional allopathic medical treatments and complementary approaches.The ideal candidate will possess excellent...


  • Tallahassee, Florida, United States The Valentino Group Full time

    Transformative Enterprise SolutionsWe are seeking a seasoned Enterprise Application Integration (EA) Engineer to lead the implementation of cutting-edge data integration solutions, enhancing our client's operations and driving business growth.Salary: $85-$90/hour, with a competitive benefits package and opportunities for professional development.About the...


  • Tallahassee, Florida, United States Integrity Locums Full time

    We are seeking a skilled Pediatric Anesthesiologist to join our team at Integrity Locums for locum coverage in Florida. This is an excellent opportunity for experienced professionals to showcase their expertise and contribute to the delivery of high-quality patient care.About the PositionThe ideal candidate will possess strong clinical skills, be comfortable...


  • Tallahassee, Florida, United States Owens & Minor, Inc. Full time

    We are a Fortune 500 company with 350+ facilities across the US and 22,000 teammates in over 90 countries. We provide integrated technologies, products, and services across the full continuum of care.As a Supply Chain Consultant at Owens & Minor, you will drive efficiencies and savings for both customers and our organization through effective interactions...


  • Tallahassee, Florida, United States Consilium Staffing, LLC Full time

    Job Title: Dental Practitioner Wanted for Full-Time Position in North FloridaAbout the Opportunity:We are seeking a skilled dentist to join our team in sunny North Florida. This is a full-time position with a competitive salary and benefits package.Estimated Salary: $150,000 - $200,000 per yearAbout the Role:The successful candidate will be responsible for...


  • Tallahassee, Florida, United States Integrity Locums Full time

    Job SummaryWe are seeking an experienced Emergency Medicine Physician with a specialization in Gastroenterology to join our team. This is a locum tenens opportunity in Florida, covering emergency GI procedures and ERCPs on a 7 on 7 off schedule. Key ResponsibilitiesPerform general GI and ERCP procedures, with a minimum of 3-4 procedures per dayCover census...


  • Tallahassee, Florida, United States Infojini Healthcare Full time

    We are seeking a skilled and dedicated Travel Nurse RN to join our team at Infojini Healthcare. Located in Leon and Gadsden Counties, this 266-bed acute-care hospital offers a range of services, including Emergency Services, Bariatric Center, Behavioral Health Center, and more.The ideal candidate will have a strong background in nursing and the ability to...


  • Tallahassee, Florida, United States Integrity Placement Group Full time

    We are seeking a highly skilled Registered Dental Hygienist to join our esteemed team in The Villages, FL. As a valued member of our team, you will have the opportunity to provide top-notch care to every patient in a warm and family-like environment.About Our Ideal CandidateFlorida Dental Hygienist License requiredOpen to new graduates with strong...