Nursing Consultant Position in Medicaid Program Integrity
7 days ago
Company Overview
The 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 Description
This is a full-time Registered Nursing Consultant position within the Bureau of Medicaid Program Integrity (MPI), budgeted for 40 hours per week, Monday-Friday 8 a.m. to 5 p.m. The selected candidate will provide professional medical consultation and technical assistance to investigators, auditors, analysts, and administrators.
Key Responsibilities
- Serving as a consultant to the management team on clinically related topics and special projects.
- Utilizing clinical knowledge and experience in interpreting medical records and comparing service documentation to submitted claims data.
- Performing medical reviews of documentation for compliance with guidelines set forth in applicable rules and Medicaid coverage and limitations policies.
- Applying knowledge of medical terminology, diagnostic and procedure coding, and Diagnosis Related Groups.
- Managing a caseload of overpayment recovery audits.
- Assuring completeness and accuracy of medical records analyses and other documentation reviews.
- Conducting prepayment reviews of Medicaid providers.
- Conducting on-site investigative reviews and interviews of Medicaid providers and recipients.
- Serving as an expert witness in administrative hearings.
- Providing training to other MPI staff on medical terminology and clinical documentation reviews.
- Communicating technical and clinical information effectively.
- Preparing accurately written and documented findings, conclusions, summary reports, and recommendations.
- Establishing and maintaining effective working relationships with other team members and stakeholders.
Required Skills and Qualifications
- Knowledge of nursing principles, practices, and techniques.
- Knowledge of human anatomy and physiology.
- Knowledge of methods of compiling, organizing, and analyzing health-related data or information.
- Knowledge of or experience with the Medicaid program.
- Ability to prioritize workload.
- Ability to apply and monitor clinical quality standards or clinical documentation improvement efforts.
- Ability to coordinate with other staff, peer reviewers, and attorneys to defend work products through the judicial process.
- Ability to travel with or without accommodations.
- Excellent written and verbal communication skills.
- Proficient in use of Microsoft Office applications.
Salary and Benefits
The estimated annual salary range for this position is $50,690.64 to $68,010.80, based on the selected candidate's qualifications and experience. As a state employee, you will enjoy a comprehensive benefits package, including health, life, dental, vision, and other supplemental insurance options, flexible spending accounts, retirement options, generous annual and sick leave benefits, 9 paid holidays a year, and career advancement opportunities.
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