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.
*** THIS RECRUITMENT MAY CLOSE AT ANY TIME BASED ON THE AMOUNT OF APPLICATIONS RECEIVED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE. ***
This position is within the Long Term Support Services (LTSS) Unit of the Division of Health Care Financing and Policy(DHCFP) and is located in Carson City. LTSS supports individuals who need ongoing care due to age, physical or intellectual disability or chronic illness. Incumbent will oversee compliance with Nursing Facilities and Intermediate Care Facilities for the individual with Intellectual Disabilities, and oversee the Medical Behaviorally Complex Care Program. Functions include developing and updating Medicaid policy based on best practices and federal and state statutes, performing trend analysis on specific programs, and ensuring federal compliance. This position will require clinical analysis to monitor quality outcomes and trends of Nursing Facility data, frequent contact with service providers, advisory groups, and recipients including the participation in community and public relations activities to assist with budgetary recommendations, program needs and outreach. The incumbent must be able to work independently and become extremely knowledgeable in all areas of Medicaid.
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.
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 case management experience including where the experience was obtained.