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.

The Health Care Coordinator II- Nurse position is within the Division of Health Care Financing and Policy's (Medicaid) Hearings Unit located in Carson City. The selected candidate for this position will be required to perform administrative and professional work in conjunction with the administration of statewide public assistance, medical assistance, or social services programs. The selected candidate for this position will be required to exercise fair, consistent, and unbiased application of all relevant policies and regulations; be required to possess a degree of knowledge and proficiency sufficient to perform work independently with minimal supervision; and required to be flexible in performing other job duties as assigned. This position will analyze, interpret and apply Federal, State and Division policy and regulations to assure an opportunity for a Fair Hearing for any recipient or provider who makes such a request; review Hearing requests to determine accuracy and completeness; review medical records to ensure accurate application of Medicaid policy citations(s) that support the adverse action; respond to recipient provider, and/or legal representative inquiries; schedule and conduct Hearing Preparation Meetings within required timeframes; schedule Fair Hearings with the Department of Administration Appeals Office within required timeframes; coordinate witnesses from Division program staff, Medicaid fiscal agent, Managed Care Organizations and other State agency staff; provide appropriate documents as well as assist the Deputy Attorney General in representing the Division at Fair Hearings; and participate in Fair Hearings on behalf of Medicaid, as appropriate. Additionally, this position will assign and coordinate work functions and processes with Administrative Assistant staff; coordinate with fiscal agent staff for data system claims programming problems and errors, correction of provider claims, prior authorization errors, and any other identified

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