APPROXIMATE ANNUAL SALARY -
$50,195.52 to
$74,813.04
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.
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Work Type: A Permanent, full time vacancy |
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Department: Health and Human Services |
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Division: Aging & Disability Services |
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Location: Carson, Minden, Gardnerville, Genoa |
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Job Class Code:
12.333
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Announcement Number: 24006
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Open to all qualified persons. |
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Posted
01/21/2015
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Recruiter:
ERIC
MAGER
Phone: **None**
Email: emager@admin.nv.gov
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Applications accepted
until recruitment needs are satisfied
** Qualified individuals are encouraged to apply immediately. Lists of eligible candidates will be established and hiring may occur early in the recruiting process. Recruitment will close without notice when a sufficient number of applications are received or a hiring decision has been made.
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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 function at the advanced journey level and either;
1) Perform the full range of duties described above and function as a team leader for assigned programs as a permanent assignment. Incumbents coordinate reviews and services, assist in training, and review complex cases with lower level Health Care Coordinators. In addition to ongoing leadworker responsibility, incumbents may serve as the primary assistant to the supervisor; develop policies and procedures; assist in the maintenance of the State plan; develop forms and provide technical assistance with the assigned programs; or 2) Serve as the statewide technical expert and provide guidance on a statewide basis to the staff of an agency such as the Division of Aging Services. Incumbents provide clarification of a condition, medication, procedure or related circumstance in case management situation; anticipate training needs, and develop and present training modules for staff; develop, implement and monitor staff compliance with State laws regarding the agency's function in the community and communicable diseases; and assist staff in developing resources and preventive health care information for the clientele served.
As part of the Community Based Care unit, this position is responsible for medical consultation and Intermediary Service Organization (ISO) evaluations, oversight of the development of plan of care for self directed services and authorization for those services, staff training and supervision, safety management, and program and policy development. Medical consultation for home and community based programs and oversight of Personal Assistance Services Program. Additionally, this position is an integral leadership position for Quality Management initiatives including coordinating team activities, provider facility and site reviews, Participant Experience Surveys and provides technical assistance to providers. These activities are all components of assurances required by CMS to ensure health, safety and welfare of program recipients.
This position provides medical consultation and guidance to Social Workers statewide who provide case management to eligible recipients in order for them to remain in the community. This position collaborates with Medicaid and Health Care Quality and Compliance to ensure providers are qualified and providing services as outlined on the plan of care. In June 2011, Aging and Disability Services Division took over the Personal Assistance Services (PAS) from St. Mary's which includes the need for a medical health care professional to perform assessments, develop plans of care, and authorize services for the skilled by unlicensed tasks that the disabled individual may need to remain in the community. This position also works closely with the provider community to ensure that policy, regulations and laws are being followed. This position is key in staff and provider training for person centered planning and evaluation and implementation of the Centers for Medicare and Medicaid Services (CMS) "New Rules" for home based settings that are required for continued qualifications and federal match payments for waiver services.
In order to be qualified, you must meet the following requirements:
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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. |
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A pre-employment criminal history check and fingerprinting are required. Persons offered employment in this position will be required to pay for fingerprinting. |
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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. |
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A valid driver's license is required at the time of appointment and as a condition of continuing employment. |
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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. |
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