Nurse Consultant 2 (Nurse Auditor)

Introduction The Department of Health Services (DHS) , Office of the Inspector General (OIG) is recruiting to fill a Nurse Consultant 2. The OIG reports directly to the DHS Secretary and is charged with protecting the taxpayers of Wisconsin by preventing and detecting fraud, abuse, and waste of public assistance programs such as Medicaid, FoodShare, WIC, IRIS, and FamilyCare. This position has the ability to work remotely up to 5 days per week but may be required to report to an office location on occasion to complete certain tasks. This position can be headquartered at one of our central or regional offices . For positions that allow remote working flexibility, working outside of Wisconsin or in bordering cities will not be allowed except in extremely limited circumstances due to the need to report to an office location in Wisconsin on short notice. As an employee of the State of Wisconsin, you'll also have access to an amazing benefits package , including:

• 3.5 weeks of vacation, 9 paid holidays and ample sick time; limitations may apply for leave time usage in the first six months .
• Top rated health plan options starting at $45/month for single plans and $111/month for family plans, after 2 months of state service.
• Exceptional pension plan with a 7.2% employer match in 2026 with lifetime retirement payment. Plus, a tax advantaged supplemental retirement savings plan which allows you to save money directly from your paycheck for retirement. Use this Total Rewards Calculator to see the total value of our competitive benefits package!
• Several flex spending accounts: medical, dependent care, commuter, parking and High Deductible Health Savings.
• Well Wisconsin Wellness Program.
• A free and confidential employee assistance program that offers employees and their immediate family dependents a variety of tools, resources, and professional consultation services to support their health, goals, and overall well-being.
• Public Service Loan Forgiveness Program employer.

Position Summary As a Nurse Consultant 2, you will be responsible for the following duties:

• Serving as the subject matter expert for questions related to claims.
• Developing and implementing program integrity strategies to detect, combat and eliminate fraud, abuse, and waste in the Medicaid program. Strategies include education, auditing, and policy recommendation.
• Conducting and reviewing documents of Medicaid providers for compliance with Administrative Code, identifying specific monetary recoveries/savings, formulating recommendations to prevent recurrence of problems and enhancing the overall efficiency and effectiveness of the Medicaid program.
• Identifying potential areas of audit activity; developing Medicaid audit capability and surveillance functions.
• Planning, coordinating, monitoring, and performing complaint investigations, utilization review, and other activities to establish and define a comprehensive audit program.
• Formulating, proposing and implementing policy initiatives, Administrative Rules and other program modifications.
• Monitoring and documenting audit follow-up activities.
• Defending audit findings as a witness in legal/administrative proceedings.
• Serving as a liaison between the OIG and other agencies involved in the detection and prevention of fraud and abuse and provides training and technical assistance to staff, other auditors, the Department of Justice, other agencies and providers.

Salary Information The starting pay is between $40.00 and $45.00 per hour (approximately between $83,200 and $93,600 per year), depending on qualifications, plus excellent benefits. A 12-month probationary period is required. Pay for current or former state employees will be set based on the rules that apply to compensation for the applicable transaction. This position is in pay schedule and range 11/03. Job Details All applicants who may be appointed to this position will be required to allow DHS to conduct a background check to determine whether the circumstances of any conviction may be related to the job being filled. Employees must have access to both a private workspace and secure high-speed internet for remote work option. Mileage reimbursement to the employee's headquarter location is not provided. Remote work flexibility will be discussed in more detail during the interview process. DHS does not sponsor work visas for this position, thus, in compliance with federal law, selected candidates will be required to verify eligibility to work in the United States by completing the required I-9 form upon hire. DHS is not an E-Verify employer nor a STEM-OPT eligible employer. This position requires the ability to drive a State vehicle or the ability to provide one's own transportation. In order to become authorized to drive a State vehicle, you must meet the requirements of the State of Wisconsin Fleet Vehicle Policy, which are:

• Must have a valid driver's license,
• Must have minimum of two years non-pr

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