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Date: Apr 16, 2018

Location: TALLAHASSEE, FL, US, 32308

The State Personnel System is an E-Verify employer. For more information click on our E-Verify website.

Requisition No: 33428 

Agency: Agency for Health Care Administration


Position Number: 68043635 

Salary:  $1,710.68 Commensurate with experience / Bi-Weekly 

Posting Closing Date: 04/25/2018 

This position is located in the Quality Performance Review section of the Bureau of Medicaid Quality and reports to the Program Administrator.  This is nursing work in planning, coordinating, and implementing utilization and monitoring control functions to support compliance in the Medicaid programs.  The employee in this position exercises independent judgment in formulating or assisting in the formulation of protocol and procedures for the purpose of monitoring compliance with Medicaid program policy. The incumbent in this position offers clinical insight and feedback regarding evaluation of program monitoring and compliance.

Examples of Work Performed:

  • Serves as consultant on all matters relating to professional nursing.
  • Makes periodic review of monitoring activities and procedures to assure compliance with nursing standards and policies.
  • Initiates and monitors studies to determine the validity of current nursing methods and practices.
  • Reviews, prepares, and submits various reports.
  • Participates in the training and research activities related to Bureau assignments.
  • Assists in the development of the overall treatment and rehabilitation plan for specialized units.
  • Provides leadership in the development of health education activities for providers, recipients and vendors.
  • Develops monitoring performance standards and measurements from a clinical perspective.
  • Develops and implements program monitoring methodologies, techniques and plans; designs, implements and monitors corrective action plans.
  • Provides in-service training on medical and health care services, patient care assessments, and utilization practices.
  • Analyzes medical services provided, prepares and analyzes various reports.
  • Performs related work as required.

Duties and Responsibilities:
Coordinate monitoring activities for Medicaid state plan services, Medicaid waivers and fee-for-service programs to ensure compliance with federal regulations, statutes, administrative rules, the Florida Medicaid state plan, and Medicaid policies and procedures. 
Work with appropriate entities to:

  • Develop plans and schedules for the review and analysis of program policies and procedures through provider monitoring;
  • Design, develop and implement monitoring tools and protocols;
  • Conduct on-site monitoring visits or desk reviews of providers and other entities as required;
  • Provide clinical consultation regarding monitoring standards, procedures and findings as needed or requested.
  • Complete reports of monitoring findings and recommend corrective action plans; and
  • Implement corrective action plans and follow-up activities as needed.
  • Prepare necessary program monitoring information for review;
  • Develop responses to findings of compliance reviews and recommendations for resolving identified areas of concern; and
  • Implement corrective action plans and follow-up activities as needed.

General Knowledge:
Remain informed about the operations of the Medicaid fiscal agent, including Medicaid claims processing, billing procedures, reimbursement methodologies, and provider enrollment.  Remain informed about Medicare and other federal and state health care related programs; including other state and national Medicaid related research and demonstration projects, long-term care and health care program innovations for special populations, and alternative financing and service delivery systems models.  Maintain knowledge regarding Medicaid State Plan, Medicaid Managed Care contract requirements, waiver regulations and processes.


  • Special projects as requested by AHCA management, Medicaid Program Integrity, Medicaid fraud unit, Inspector General’s office, or other Agency office as assigned by incumbent’s supervisor.
  • Perform other duties and responsibilities as required.


This position requires travel.



  • Knowledge of nursing principles, practices and techniques, human anatomy and physiology.
  • Knowledge of principles and practices of health care management.
  • Knowledge of methods of compiling, organizing and analyzing data.
  • Ability to develop and implement various program monitoring protocols, procedures, methodologies and techniques.
  • Ability to provide in-service training on medical and health care services, patient assessments, and utilization practices.
  • Ability to understand and apply applicable rules, regulations, policies and procedures.
  • Ability to utilize microcomputer and software to enter, retrieve, and manipulate data required to perform program monitoring.
  • Ability to plan, organize and prioritize work assignments.
  • Ability to develop various reports.
  • Ability to formulate and monitor nursing standards and operating policies and procedures.
  • Ability to establish and maintain effective working relationships with others.
  • Skills are needed in the techniques of written and oral communication, especially attentive listening, interview procedures, and methods of documentation review.
  • Ability to travel with or without accommodations.



  • Licensure as a Registered Professional Nurse in accordance with Florida Statute 464 or eligible to practice nursing in accordance with Florida Administrative Code 210-8.27 and two years of professional nursing experience.
  • A bachelor's degree from an accredited college or university with a major in nursing can substitute for one year of the required general professional nursing experience.
  • A master's degree from an accredited college or university in nursing can substitute for two years of the required general professional nursing experience.



The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement. 

Nearest Major Market: Tallahassee