For more information on benefit and retirement programs, please see the sections below.
In order to receive consideration, applicants must indicate their availability for any work type, travel, and location requirements listed.

Health Care Coordinators perform professional work related to program operations and auditing providers to ensure compliance with program policies and regulations. Assess potential client needs for case management services using assessment tools to identify social service and/or medical needs; participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of services and resident care. Review health care providers and fiscal agents to ensure clients are receiving appropriate services and payment is correct for services received, process payment authorization requests from providers to ensure the requested service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests. Review records from the fiscal agent, providers, clients and computer generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by the fiscal agent. Explain proper billing procedures to contract providers selected by the client; monitor the quality of care given by the provider to clients; and submit billings for services provided to the fiscal agent for payment.

Incumbents perform the full range of duties described above. In addition, incumbents at this level may intermittently serve as the project lead of a case management team, function as coordinator of a specifically assigned protion of a program, and assist in training other Health care Coordinators and providers. This is the journey level of the series.

This position is within the Hearings Unit of the Division of Health Care Financing and Policy, and will be located at the Las Vegas Medicaid District Office. This position is responsible for the provisions of and representation of the agency at Administrative Fair Hearings for Medicaid/NV Check-Up Providers and Recipients, in accordance with Medicaid Service Manual, Hearings Program. This position is required to interpret and apply various Medicaid services program policies, as well as state and federal regulations. Additionally, this position is responsible to review medical records and reports to establish if medical claims were adjudicated correctly and in accordance with program policies, as well as to establish and ensure correct application of various Medicaid/NV Check-Up service policies of utilization management adverse determinations. This position is required to attend and represent the agency at Administrative Fair Hearings.

In order to be qualified, you must meet the following requirements: