APPROXIMATE ANNUAL SALARY -
$48,462.48 to
$72,223.92
PAY GRADE: 37
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.
This position is a health Care Coordinator III-Nurse position in the Central Office. This position is a resource and provides oversight and coordination for Minimum Data Set (MDS) Case Mix Verification, the MDS Facility Reviews and the Quality Review process. This position is also a resource and provides oversight for the Pre-Admission Screening and Residential Review (PASRR) program and Nursing Facility Level of Care (LOC). This position works with the Fiscal Agent and other Divisions. Assists in evaluating policy and program development, including the interpretation of federal and state regulations and assists in designing data collection systems, forms, spreadsheets, and procedures to collect and analyze quantified, aggregate program data for trending and reporting as needed.
In order to be qualified, you must meet the following requirements:
Education and Experience (Minimum Qualifications)
Licensure as a Registered Nurse and two years of professional experience providing case management services in a social or health related field; OR one year of experience as a Health Care Coordinator II - Nurse in Nevada State service; OR licensure and an equivalent combination of education and experience.
Special Requirements
A pre-employment criminal history check and fingerprinting are required. Persons offered employment in this position will be required to pay for fingerprinting.
A State of Nevada/FBI background check will be required of the selected applicant.
Professional licensure as a registered nurse or certification in a medical specialty issued by the appropriate licensing board in the State of Nevada is required at the time of appointment and as a condition of continuing employment.
A valid driver's license is required at the time of appointment and as a condition of continuing employment.
The Examination
Application Evaluation Exam
The exam will consist of an application evaluation. It is essential that applications include detailed information with time frames regarding education and experience. The most qualified applicants will be contacted by the hiring agency for interview. The hiring agency may require specific skills related testing as part of the interviewing process.
