Registered Nursing Consultant

Requisition No: 840666 Agency: Agency for Health Care Administration Working Title: - REGISTERED NURSING CONSULTANT Pay Plan: Career Service Position Number: Salary: $1,949.64 - $2,615.80 Biweekly Posting Closing Date: 01/07/2025 Total Compensation Estimator Tool Agency Overview: The Agency for Health Care Administration is Florida's chief health policy and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives. Position Overview: 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 $50,690.64 to $68,010.80 yearly, 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. Benefits of Working for the State of Florida: Working for the State of Florida is more than a paycheck. The State's total compensation package for employees features a highly competitive set of employee benefits including: State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options; Flexible Spending Accounts; State of Florida retirement options, including employer contributions; Generous annual and sick leave benefits; 9 paid holidays a year and 1 Personal Holiday each year; Career advancement opportunities; Tuition waiver for coures offered by Florida's nationally ranked State University System ; Training and professional development opportunities; And more. For more information on MPI, please visit MPI at: 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. MINIMUM QUALIFICATIONS REQUIREMENTS Licensed as a Registered Professional Nurse in accordance with Chapter 464, Florida Statutes and in accordance with Rule 64B9, Florida Administrative Code 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 professional nursing experience. A master's degree from an accredited college or university in nursing can substitute for two years of the required professional nursing experience. LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS Licensed as a Registered Professional Nurse in accordance with Chapter 464, Florida Statutes and in accordance with Rule 64B9, Florida Administrative Code. CONTACT: HELEN GUNN BACKGROUND SCREENING It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies. 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-). 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. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy ) 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. Location: TALLAHASSEE, FL, US, 32308