Medicaid Program Integrity RN Consultant

My Florida Families; Tallahassee (FL); On-site; USD 62,000 - 76,000; Full time

Benefits offered by this job

No state income tax for Florida

State Group Insurance coverage options

VALIC 401(a) retirement plan

457(b) Deferred compensation

Job summary

The Florida Agency for Health Care Administration seeks a full-time Registered Nursing Consultant to conduct audits of Medicaid providers and ensure compliance with Medicaid provisions and state/federal regulations. The role emphasizes investigations, reporting, and collaboration within the Bureau of Medicaid Program Integrity (MPI) in Tallahassee.

Candidate must be a Florida-licensed RN with 3 years of nursing experience; APRN or higher degrees are preferred. Travel up to 10% may be required.

Qualifications

• Licensed RN in Florida with 3 years of nursing experience.
• Bachelor's or Master's degree in Nursing preferred.
• APRN eligibility preferred.
• Willingness to travel up to 10%.

Responsibilities

• Conduct desk or onsite records reviews to determine documentation sufficiency and compliance with Medicaid provisions.
• Develop findings and recommendations for overpayments, sanctions, and referrals to law enforcement partners.
• Interpret claims in the context of clinical standards, policy requirements, and utilization patterns.
• Identify deficiencies, patterns of noncompliance, and opportunities for provider education or corrective action.
• Prepare testimony, exhibits, and expert statements with agency counsel to articulate clinical rationale and audit findings.
• Collaborate with MPI team members on projects and provide internal consultation and training.

Skills

Nursing principles

Health data analysis

Medicaid program knowledge

Time management

Independent work

Verbal & written communication

Education

Bachelor's degree in Nursing

Master's degree in Nursing

Job description

The Florida Agency for Health Care Administration seeks a full-time Registered Nursing Consultant to conduct audits of Medicaid providers and ensure compliance with Medicaid provisions and state/federal regulations. The role emphasizes investigations, reporting, and collaboration within the Bureau of Medicaid Program Integrity (MPI) in Tallahassee.

Candidate must be a Florida-licensed RN with 3 years of nursing experience; APRN or higher degrees are preferred. Travel up to 10% may be required.