Nurse Consultant 2 (Nurse Auditor)

🌍 Remote, USA 🚀 Full-time 🕐 Posted Recently

Job Description

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.

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

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.

Must have a valid driver's license,
Must have minimum of two years non-probationary licensed driving experience with a regular (Class D) driver's license,
Must be 18 years of age.
Three or more moving violations and/or at-fault accidents in the past two years,
Operating While Intoxicated (OWI)/Driving Under the Influence (DUI) citation within the past 12 months,
Suspension or revocation of driver's license.

Qualifications

Licensed or eligible for unrestricted licensure as a Registered Nurse (RN) in the State of Wisconsin. Eligible is defined as: you currently hold a license in another state and are eligible to obtain licensure in the State of Wisconsin. License must be obtained by time of appointment.
Experience working with medical coding (e.g. examining medical records, reviewing codes assigned to procedures and diagnoses, referencing national medical billing coding system, etc.).
Experience working as an RN performing direct care activities in two or more clinical specialties (e.g., working in the same hospital in ICU and pediatrics would qualify) OR increasing responsibilities in one clinical specialty (e.g., floor nurse to charge nurse in one clinical specialty would qualify).
Experience working as an RN in one or more of the following areas: Therapy Clinic, Rehabilitation Center, Vision Services, Case Management, or Utilization Review.
Experience working in rehabilitation with skilled therapy services (physical, occupational, or speech) such as in a skilled nursing facility.
Experience with program integrity activities such as reviewing medical records for compliance with policies.
Experience performing documentation review for physical, occupational, or speech therapy services.
Experience developing or participating in developing policies or procedures in a medical or legal setting.
Experience critiquing or providing feedback to peers such as reviewing completed work for missing details.

How To Apply

Applying is easy! Click "Apply for Job" to start your application process. Sign in to your account or create an account before applying for the job. Follow the steps outlined in the application process and submit your application.

Once your application is submitted, no changes are allowed. Click "Save" to allow changes to your application as needed before submitting by the deadline.
You may want to save a copy of the job posting for referencing after the deadline.
Submitted materials will be evaluated by a panel of job experts according to the qualifications above.
Please monitor your email for communications related to this position.
Current or former permanent, classified, state employees must complete the online application process to be considered.
If viewing through an external site, please apply directly at Wisc.Jobs .
For technical assistance and general information, please see Frequently Asked Questions . For questions about the position, to request a copy of the full position description, or for other employment inquiries, please contact Jacque Strook in Human Resources at [email protected] .

Deadline to Apply

The deadline to apply is March 25, 2026, by 11:59 pm.

Applicants are strongly encouraged to allow ample time to finalize their applications keeping in mind that technical assistance is only available Monday through Friday 7:45 am - 4:30 pm. Late or incomplete applications will not be accepted.

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