APPROXIMATE ANNUAL SALARY -
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.
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 with the Department of Health and Human Services in the Division of Health Care Financing and Policy (DHCFP/Medicaid), Policy Development and Program Management Unit, and is located in Carson City, NV. This position is responsible for the development, implementation, management, and evaluation of the medical coverage policies and procedures for the Inpatient and Outpatient Hospital Program. The incumbent will be required to research/analyze federal and state regulations and other best practices. The incumbent will be required to work with contractors, providers, and other stakeholders to perform education and outreach on policies and procedures and is required to manage tasks in an independent manner.
In order to be qualified, you must meet the following requirements:
Education and Experience (Minimum Qualifications)
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.
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 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.
Travel up to 25%.
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.