Wisconsin Licensed Nurse Consultant

Job Summary

To support the Office of Inspector General's pre-payment activities, the fully remote Wisconsin Licensed Nurse Consultant will conduct clinical and financial compliance reviews to detect and eliminate fraud, waste, and abuse in the Medicaid program while developing and implementing relevant policies and guidelines.

Key responsibilities

• Conduct comprehensive medical record reviews and analyze complex datasets to ensure compliance with Medicaid regulations
• Develop and implement pre-payment review criteria and policies that align with OIG program objectives
• Prepare and present findings from audits and investigations, ensuring clarity and adherence to state Medicaid standards

Required qualifications

• Current Wisconsin Registered Nurse license issued by the Wisconsin Department of Safety and Professional Services
• Strong knowledge of federal and state regulations related to Medicaid programs
• Experience in assessing health service utilization patterns through statistical data analysis
• Ability to develop medical policies and standards based on comprehensive medical knowledge
• Proficiency in using computer databases and technology relevant to pre-payment review audits