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Date: Dec 6, 2018

Location: TALLAHASSEE, FL, US, 32399

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

Requisition No: 49882 

Agency: Financial Services


Position Number: 43005006 

Salary:  $44,477.64 - $99,056.88 

Posting Closing Date: 12/20/2018 







A Bachelor’s degree or higher from an accredited college or university and two (2) or more years of nursing experience, OR an associate’s degree from an accredited college or university and four (4) or more years of nursing experience is required.

An active Florida Registered Nurse’s license in good standing is required.

Preference will be given to applicants with the following experience:

  • Workers’ Compensation.
  • Nurse case management.
  • Two (2) or more years of medical billing.

The annual base minimum for this position is $44,477.64

This position requires a security background check as a condition of employment.

Employees of the Department of Financial Services are paid on a monthly pay cycle.

Responses to qualifying questions must be clearly supported by the State application and any omission, falsification or misrepresentation in the answering of the qualifying questions will be cause for immediate elimination from the selection process.  

Minimum Qualifications for this position include the following REQUIRED ENTRY LEVEL KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of nursing principles practices, and techniques; knowledge of human anatomy and physiology; knowledge of methods of compiling, organizing, and analyzing data; ability to develop and implement various program monitoring methodologies and techniques; ability to provide in-service training on medical and health care services, patients assessments, and utilization practices; ability to develop program policy, procedures, manuals, administrative rules and agreements; ability to understand and apply applicable rules, regulations, policies and procedures; ability to prioritize work load; ability to plan, organize and coordinate 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; ability to communicate effectively.


This is complex nursing work within the Bureau of Monitoring & Audit, Medical Services Section administering and implementing medical reimbursement standards in the dispute resolution process pursuant to s. 440.13(7), Florida Statutes (F.S.) and rule 59A- 31, Florida Administrative Code (F.A.C.).  This position exercises independent judgment in the application of statutes and relevant administrative rules governing eligibility for reimbursement and reimbursement methodology and requires extensive knowledge of laws, statutes, and rules throughout the State of Florida.

Issues formal written documents for the purpose of resolving reimbursement and utilization dispute petitions filed with the Agency, by health care providers, to contest insurance carrier medical bill adjustments and disallowances, pursuant to s. 440.13(7), Florida Statutes (F.S.) and rule 59A- 31, Florida Administrative Code (F.A.C.).  Researches applicable statutes and relevant administrative rules governing both the provider’s eligibility for reimbursement and the carrier’s reimbursement methodology, including schedules of maximum reimbursement allowances and other additional documentation submitted by either party to the reviewer.  Ensures that each Determination or Dismissal issued addresses the basis of the dispute as framed by the parties to the dispute, according to their submissions to the Agency.  Ensures that the rationale for each Determination or Dismissal is based on specific statutory and regulatory authority that must be cited in the document.  Provides detailed, accurate calculations demonstrating how each Determination is derived.  Maintains real time documentation of status of petitions under review, including issues in dispute, which may be used for annual reporting to the Three Member Panel pursuant to s. 440.13(12), F.S.

Evaluates carrier reports of health care provider overutilization, submitted to the   Agency pursuant to s. 440.13(8), F.S., to determine whether a pattern or practice of overutilization exists and whether penalties may be appropriately imposed by the Agency, based on applicable administrative rules, assistance from Expert Medical Advisors, and other data documenting services rendered in a specific case or in multiple cases that may be obtained from the Division of workers’ compensation.  Also, investigates health care providers pursuant to s. 440.13(11), F.S., to determine improper billing practices, engaging in overutilization, and compliance with rules adopted by the agency.

Consults with non-nursing professional staff, as may be required to accomplish Unit functions related to utilization review or the proper certification of health care providers and expert medical advisors, and which may include providing answers to medical billing questions, interpretation of medical information or criteria related to medical necessity, standards of care or practice parameters and protocols.  Responds to system stakeholders to provide technical assistance or clarification of regulatory requirements and to disseminate information to promote the efficient, cost-effective delivery of medical benefits, which may include participation in workgroups to develop electronic training materials or formal presentations at workshops, seminars, and conferences, as assigned.

Participates in ad hoc workgroups to review and provide input in to the development or revision of internal operating procedures, administrative rules, manuals, or special reports

If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement.


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