Nursing Consultant

The Department of Health Services, Division of Medicaid Services (DMS) is recruiting for a Nursing Consultant in the Bureau of Clinical Policy & Pharmacy (BCPP).

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.
• Top rated health plan options starting at $39/month for single plans and $97/month for family plans, after 2 months of state service.
• An exceptional pension plan with employer match and lifetime retirement payment, plus an optional tax advantaged 457 retirement savings plan. Use this Total Rewards Calculator to see the total value of our competitive benefits package!
• Public Service Loan Forgiveness Program employer.

This position has the ability to work remotely up to 5 days per week but may be required to report to the central office location on occasion to complete certain tasks. This position is headquartered at 1 West Wilson Street in Madison, WI.

As the Nursing Consultant, you will collaborate with multiple Medicaid specialties, Bureaus, and Departments to provide clinical input and develop system configurations to assist with developing, maintaining, and modifying ForwardHealth program policies and guidelines. You will coordinate, plan, develop, and implement the statewide complex Medicaid benefit of Immunizations. You will be the Division’s liaison to the Medicaid Medical Director, the Division of Public Health (DPH), the Division of Care and Treatment Services (DCTS), and various other internal and external partners. You will also be the primary subject matter expert for medical informatics and medical specialties, in collaboration with the Medicaid Medical Director. The position consults with and provides oversight of Wisconsin fee-for-service and managed care clinical quality programs.

Responsibilities include:

• Using nursing informatics practices to promote evidence-based practice.
• Developing clinical and benefits policy for the Immunization benefit area.
• Performing research and data analysis on new and existing programs for efficacy and integrity.
• Ensuring quality assurance through claims and configuration analysis, clinical policy review, and data analytics, and providing consultative support of service authorization (SA).
• Serving as a spokesperson and educator for medical clinical policy in interactions with the provider community, Medicaid members, DMS, DPH, and other DHS staff.
• Developing and providing training to DMS, DPH, and other DHS staff, providers, members, and other agencies.
• Formulating, proposing, and implementing clinical policy initiatives and Administrative Rules.
• Conducting utilization reviews of ForwardHealth services in accordance with best nursing informatics practices.

The starting salary is between $38.50 and $43.34 per hour (approximately between $80,000 and $90,100 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 classified as a Nursing Consultant 2 and is in pay schedule and range 11/03.

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.

For positions that do allow remote working flexibility, although residency in the State of WI is not required for permanent positions, it is not anticipated that working outside of WI or bordering cities will be allowed as positions may at times need to report to office locations in WI on short notice.

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.

Employees must have access to 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.

Minimally qualified applicants will have all of the following:

• Licensure or eligibility* for licensure as a Registered Nurse (RN) in the State of Wisconsin (WI). Candidate must be licensed in WI by the time of appointment.
• Experience working as an RN in a clinical setting or specialty area.
• Experience interpreting and applying program guidelines, standards, and federal and state regulations.

• Eligibility is defined as licensed in another state and eligible to be licensed in WI by the time of appointment.

Well-qualified applicants will also have one or more of the following:

• Experience conducting utilization review of durable medical equipment and/or supplies.
• Experience training multiple types of individuals (e.g., clinicians, families, therapists, etc.) on RN-related policies.
• Experience interpreting and applying Medicaid policy and prior authorization guidelines related to medical services.

Your letter of qualifications is limited to one (1) page. For a guide on developing your resume and letter of qualifications and what should be included in these materials, click here.

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

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Submitted materials will be evaluated by a panel of job experts according to the qualifications above. Please monitor your email for communications related 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.

DHS is an Equal Opportunity and Affirmative Action employer seeking a diverse and talented workforce.

Veterans are encouraged to apply. For complete information on veterans’ hiring programs with the WI Department of Veteran’s affairs, click here.

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 HR Specialist, Allyvia Vang at allyviam.vang@dhs.wisconsin.gov.

The deadline to apply is April 15th at 11:59 pm.