RN Auditor for Medicaid Program Integrity

State of Florida

Tallahassee (FL)

On-site

USD 3,790,000 - 5,398,000

Full time

6 days ago

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Benefits offered by this job

No state income tax for Florida

Health, life, dental, vision insurance

Valic 401(a) plan

457b Deferred Compensation

Job summary

State of Florida is seeking a Registered Nursing Consultant to conduct comprehensive audits of Medicaid providers, identify noncompliance patterns, and prepare findings for enforcement actions. The role involves collaboration across MPI, producing audit reports, and presenting regulatory rationale in hearings.

The position requires Florida RN/APRN licensure with at least three years of nursing experience; travel of 1–10% is possible, and background checks are required.

Qualifications

Licensed Registered Nurse in Florida with 3 years of nursing experience.
Bachelor’s degree in nursing preferred; Master’s degree preferred.

Responsibilities

Conduct audits of Medicaid providers for compliance with policies and regulations.
Identify aberrant billing patterns and potential fraud or abuse.
Prepare summary reports and referrals to law enforcement as needed.
Serve as expert witness in administrative hearings and present regulatory rationale.

Skills

Nursing knowledge

Auditing

Regulatory interpretation

Investigation coordination

Documentation & reports

Communication (oral & written)

Independent work

Travel readiness

Education

Bachelor of Science in Nursing (BSN)

Master’s degree in nursing

Tools

MS Word

MS Excel

Outlook

PowerPoint

SharePoint

Job description

The position requires Florida RN/APRN licensure with at least three years of nursing experience; travel of 1–10% is possible, and background checks are required.

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