Nurse Auditor

Overview

Vermont Medicaid's Special Investigation Unit is looking for a Nurse Auditor to assist with investigative, analytical, and consultative work at a professional level for DVHA involving health insurance and health care delivery systems. Work in a supportive environment with a Monday‑Friday schedule, eleven paid state holidays, and a robust benefits package.

Duties include the identification of unusual beneficiary and provider utilization patterns, procedural deficiencies in the reporting and claiming of reimbursement for services, and ensuring services are medically necessary. Extensive knowledge and interpretation of medical claims billing policies, practices, and claims processing are essential. Duties are performed under the direction of the Special Investigations Unit Manager and involve extensive interaction with medical service providers, Division Directors, Agency of Human Services program managers, state program managers, and Federal officials.

The Department of Vermont Health Access (DVHA) mission is to improve Vermonters' health and well‑being by providing access to high‑quality, cost‑effective health care. DVHA supports three priorities: advancing value‑based payments, modernizing information technology infrastructure, and operational performance improvement. DVHA commits to executing its responsibilities while adhering to transparency, integrity, and service.

DVHA is committed to supporting diversity, equity, inclusion, and accessibility within a person‑centered culture, celebrating all abilities, racial identities, sexual orientations, ethnicities, ages, and genders.

Vermont is a small but mighty state, ranked among the top 10 families 2022. It offers progressive social policies, beautiful natural scenery, and year‑round outdoor activities.

This position,
Nurse Auditor (Job Requisition #54407), is open to all state employees and external applicants.

For more information, contact Meesha O’Brein ien. Resumes will not be accepted via e‑mail; apply online.

Candidates must pass applicable background investigation, including criminal record, DMV, and abuse registry checks, in accordance with AHS policy.

Duties may be performed in an office setting or in the field; personal transportation is required. Some functions may require work outside normal hours. Effective communication with a diverse stakeholder group is essential.

• Registered Nurse (RN) licensure in Vermont, or eligibility to practice in Vermont via a multi‑state license.

• Three (3) years or more of professional nursing experience in an acute care hospital, health insurance carrier, or community health setting.

• Bachelor of Science in Nursing (BSN).

Reliable personal transportation is required for outside‑office work. Candidates must maintain Vermont RN licensure or eligible multi‑state license.

The State offers a comprehensive benefits package worth about 30% of compensation, including:

• 80% state‑paid medical premium and a dental plan at no cost for employees and families
• 11 paid holidays and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• State defined benefit pension plan and a 457(b) deferred compensation plan
• Tuition reimbursement
• Flexible spending, healthcare and childcare reimbursement accounts
• Low‑cost group life insurance
• Incentive‑based wellness program
• Qualified Employer for Public Service Student Loan Forgiveness Program

The State of Vermont celebrates diversity and is committed to providing an environment of mutual respect and meaningful inclusion. The State does not discriminate on the basis of race, color, religion, national origin, sex, age, disability, HIV status, sexual orientation, gender identity, marital status, military service, employee organization membership, family medical history, or genetic information.