Requisition No: 228801
Agency: Agency for Health Care Administration
Working Title: 68063495 – REGISTERED NURSING CONSULTANT
Position Number: 68063495
Salary: $1,710.68- $2,432.05 BI WEEKLY
Posting Closing Date: 09/16/2020
This is a full time Registered Nursing Consultant position within the Bureau of Medicaid Program Integrity (MPI), and is budgeted for 40 hours per week, Monday-Friday 8 a.m. to 5 p.m. This position is anticipated to be filled at the salary range of $44,477.68 to $63,233.30 annually, based upon the selected candidate’s qualifications and experience. This position may involve travel related activities from 1-10%. Successful completion of a criminal background investigation is a condition of employment.
This is an opportunity for a Registered Nurse (RN) or an Advanced Practice Registered Nurse (APRN) working in Tallahassee within the Agency’s Bureau of Medicaid Program Integrity (MPI). MPI serves as the primary organizational unit within the Agency for the purposes of prevention, detection, and recoupment/enforcement related to Medicaid program oversight, as well as the lead unit for compliance with contractual and statutory requirements related to fraud and abuse activities.
This is a highly responsible professional and clinical position. The selected candidate is responsible for providing professional medical consultation and technical assistance to investigators, auditors, analysts, and administrators. The selected candidate must be a Florida licensed Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN).
The selected candidate will assist in a variety of operational, administrative, and clinical functions. Included in these functions are activities such as:
- 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.
- Interacting regularly with other clinicians, analysts, investigators, and administrators.
The selected candidate will also be involved in activities of a broader nature within the Bureau, to support the Agency’s overall mission.
MPI provides a multitude of training opportunities for all MPI employees to enhance their professional growth. This position offers an excellent array of benefits, including:
•Dental, vision and supplemental insurance
•Vacation and sick leave
•Opportunities for career advancement
•Tuition waiver for public college courses
For more information, please view MPI's section of "Florida's Efforts to Control Medicaid Fraud and Abuse FY 2018-2019" located at: http://ahca.myflorida.com/MCHQ/MPI/docs/FraudReports/FraudReport2018-19.pdf
KNOWLEDGE, SKILLS, AND ABILITIES:
- 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.
- 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.
- A master's degree from an accredited college or university in nursing can substitute for two years of the required general professional nursing experience.
CONTACT PERSON: Sterling Abney 850-412-4645
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.
Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.
VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.