Title:  Nurse Auditor

Application Deadline Date:  07/23/2024
Req ID:  50489
Department:  Vermont Health Access

Waterbury, VT, US

Position Type:  Permanent
Schedule Type:  Full Time
Hourly Rate:  $36.61


Prevent, detect, and investigate potential Medicaid fraud & abuse at the Department of Vermont Health Access (DVHA). Help Vermonters by joining DVHA's Special Investigations Unit (SIU)'s committed team as a Nurse Auditor.
Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment. Eleven paid state holidays, in addition to a robust benefits package.

The Nurse Auditor position has the following responsibilities:
·    Contribute to the mission of the Special Investigations Unit (SIU) to prevent, detect, and investigate allegations of potential fraud and abuse within Vermont Medicaid.
·    Professional review and evaluation of medical record documentation to assist in determining medical necessity, proper coding, and that payments are being made appropriately. Medical documentation may include, but is not limited to: inpatient and outpatient procedures and services, durable medical equipment, high-tech nursing services, home healthcare, etc.
·    Maintain and organize components of case files and be proficient with writing investigation reports that summarize their work and findings. 
·    Assists in the determination and identification of unusual beneficiary and provider utilization patterns, the claiming of reimbursement for services in all Medicaid programs, and the preparation of reports based on the review and findings.
·    Extensive interaction with other team members, Medicaid providers and recipients, provider site visits, and state and federal partners.  
The Nurse Auditor position requires Licensure as a Registered Nurse.

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

The Department of Vermont Health Access (DVHA) supports a hybrid work environment. Upon hire, employees work with their supervisor to create a schedule that aligns with the business needs of the unit. We believe a hybrid work environment promotes autonomy and allows for increased flexibility and greater work/life balance.
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.

Who May Apply

This position, Nurse Auditor (Job Requisition #50489), is open to all State employees and external applicants.
If you would like more information about this position, please contact kristy.cross@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 OR eligible to practice in the state of Vermont via a multi-state license 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).

NOTE: Must maintain Vermont licensure as a Registered Nurse OR eligible to practice in the state of Vermont via a multi-state license 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.

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 and a dental plan at no cost for employees and their families
  • Work/Life balance: 11 paid holidays each year and a generous leave plan
  • State Paid Family and Medical Leave Insurance (FMLI)
  • Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
  • Tuition Reimbursement
  • Flexible spending healthcare and childcare reimbursement accounts
  • Low cost group life insurance
  • 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.

Equal Opportunity Employer

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.

Nearest Major Market: Barre
Nearest Secondary Market: Montpelier