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Title:  Nurse Auditor - Limited Service

Application Deadline Date:  04/21/2021
Req ID:  13925
Department:  Vermont Health Access

Waterbury, VT, US

Position Type:  Limited Service
Schedule Type:  Full Time
Hourly Rate:  $32.62


The Department of Vermont Health Access (DVHA)'s mission is to improve the health and well-being of Vermonters by providing access to quality healthcare cost effectively. We have three priorities that support us in moving our mission forward: Adoption of value-based payments, management of information technology projects, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service. 

DVHA's Program Integrity Unit (PI) is seeking a qualified individual to join their dynamic team.


This position contributes to the mission of Program Integrity to prevent, detect, and investigate allegations of potential fraud and abuse within Vermont Medicaid.  A Nurse Auditor in PI is primarily responsible for the professional review and evaluation of medical record documentation to assist in determining medical necessity and appropriateness.  Medical documentation may include, but is not limited to: inpatient and outpatient services, clinical procedures, durable medical equipment, high-tech nursing services, in home care coordination, etc. This position also assists in the determination and identification of unusual beneficiary and provider utilization patterns, the claiming of reimbursement for services in these programs, and the preparation of reports based on the findings.  Position involves extensive interaction with other team members, clinical staff, Medicaid providers, and state and federal partners.

Who May Apply

This position, Nurse Auditor - Limited Service (Job Requisition #13925), is open to all State employees and external applicants.

It is a Limited Service position, which is non-tenured and authorized for a specific period of time. Limited Service positions are established for specially funded projects or programs. 
If you would like more information about this position, please contact Nadeth.Fitzgerald@vermont.gov.
Resumes will not be accepted via e-mail.  You must apply online to be considered.
Please note that multiple positions in the same work location may be filled from this job posting.


AHS BACKGROUND CHECKS:  Candidates must pass any level of background investigation applicable to the position.  In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Environmental Factors

Duties may be performed in either an office setting or, a combination of office and in the field, for which a private means of transportation will be required for necessary travel. Certain functions may require duty outside of normal work hours. Duties require the need for effective communication and working relationships with a diverse group of stakeholders, including beneficiaries, providers and operational integration with various other health care reform initiatives supported by AHS. Pressure of deadlines and investigative needs may require some work outside of normal office hours.

Minimum Qualifications

Possession of (or eligible for) licensure as a Registered Nurse (RN) in Vermont and three (3) years or more of professional nursing experience in an acute care hospital, health insurance carrier, or within a community health setting.

Preferred Qualifications

Bachelor of Science in Nursing (BSN).

Prior experience in the review of medical documentation to determine medical necessity is desired.


NOTE: Must maintain Vermont licensure as a Registered Nurse as a condition of employment.

Special Requirements

Reliable means of personal transportation is required for work out of the office or in the community and field based settings.


Candidates must pass any level of background investigation applicable to the position. In accordance with applicable hiring standards, fingerprint supported criminal record checks, adult and child abuse registry checks, the Office of Inspector General exclusion database, and motor vehicle driving record checks, as appropriate to the positon under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion, or demotion into a classified position or are persons exercising re-employment (RIF) rights.

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:
  • 80% State paid medical premium
  • Dental Plan at no cost for employees and their families
  • Flexible Spending healthcare and childcare reimbursement accounts
  • Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
  • Work/Life balance: 11 paid holidays each year and a generous leave plan; many jobs also allow for a flexible schedule
  • Low cost group life insurance
  • Tuition Reimbursement
  • Incentive-based Wellness Program
  • Qualified Employer for Public Service Student Loan Forgiveness Program
Want the specifics? Explore the Benefits of State Employment on our website.

AHS Affirmative Recruitment

The Vermont Agency of Human Services strives to build a diverse and inclusive community. It is our fundamental belief that in order to create and sustain a healthier Vermont, we as an organization must honor the cultures, beliefs and values of those we serve in order to foster an environment of mutual respect, acceptance and equal opportunity.  We are committed to building and maintaining a multicultural and diverse workforce which reflects the increasing diversity of Vermont. To view the State of Vermont's Equal Employment Opportunity/Affirmative Action Policy, please click here.

Equal Opportunity Employer

The State of Vermont is an Equal Opportunity Employer. Applications from women, individuals with disabilities, veterans, and people from diverse cultural backgrounds are encouraged.

Nearest Major Market: Barre
Nearest Secondary Market: Montpelier