APPROXIMATE ANNUAL SALARY -
PAY GRADE: 36
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.
The Health Care Coordinator will work in the Behavioral Health section of the Clinical Policy Team. This position is responsible for overseeing the Residential Treatment Centers/Psychiatric Residential Treatment Facilities, Inpatient Psychiatric Hospitals and Targeted Case Management. The incumbent will be required to research/analyze federal and state regulations and other best practices. The incumbent will be required to work with contracted staff, providers, other state agencies, and stakeholders to educate and outreach on policies and procedures. The incumbent will be responsible for working directly with providers to assist in facilitating placements when necessary. The incumbent must have the ability to use Microsoft Office programs and the ability to travel up to 25%. A behavioral health background is preferred.
In order to be qualified, you must meet the following requirements:
Education and Experience (Minimum Qualifications)
Licensure as a Registered Nurse and one year of professional experience providing case management services in a social or health related field; OR one year of experience as a Health Care Coordinator I - Nurse in Nevada State service; OR licensure and an equivalent combination of education and experience.
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 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.
Microsoft Office Suite
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.
The following additional questions are part of this Recruitment
1) Please describe your experience providing case management in a social or health related field. Please include where the experience was obtained.