APPROXIMATE ANNUAL SALARY -
PAY GRADE: 38
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 the Supervisor (HCC IV-RN) of the Carson City Medicaid District Office within Department of Health and Human Services (DHHS)/Division of Health Care Financing and Policy (DHCFP). Incumbent must work directly with Medicaid recipients to provide care coordination when necessary. The incumbent must be able to work independently, become extremely knowledgeable in all areas of Medicaid, and develop an understanding of Welfare eligibility. Incumbent must ensure program compliance is maintained in all areas operated within the District offices. Incumbent is required to participate and lead in Minimum Data Set (MDS) facility reviews.
In order to be qualified, you must meet the following requirements:
Education and Experience (Minimum Qualifications)
Licensure as a Registered Nurse and three years of experience providing case management services in a social or health related field, one year of which included the interpretation and application of Medicaid policies and procedures, coordinating reviews and services, training staff and reviewing complex cases; OR licensure and an equivalent combination of education and experience.
A pre-employment criminal history check and fingerprinting are required.
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.
A valid driver's license is required at the time of appointment and as a condition of continuing employment.
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
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.