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.
Incumbents function at the advanced journey level and either;
1) Perform the full range of duties described above and function as a team leader for assigned programs as a permanent assignment. Incumbents coordinate reviews and services, assist in training, and review complex cases with lower level Health Care Coordinators. In addition to ongoing leadworker responsibility, incumbents may serve as the primary assistant to the supervisor; develop policies and procedures; assist in the maintenance of the State plan; develop forms and provide technical assistance with the assigned programs; or 2) Serve as the statewide technical expert and provide guidance on a statewide basis to the staff of an agency such as the Division of Aging Services. Incumbents provide clarification of a condition, medication, procedure or related circumstance in case management situation; anticipate training needs, and develop and present training modules for staff; develop, implement and monitor staff compliance with State laws regarding the agency's function in the community and communicable diseases; and assist staff in developing resources and preventive health care information for the clientele served.
This position is with the Department of Health and Human Services in the Division of Health Care Financing and Policy (DHCFP/Medicaid) and is located at the DHCFP Las Vegas District Office. This position requires less than fifty percent of time traveling within the Las Vegas District Office catchment area.
Health Care Coordinators (HCC's) in this unit evaluate individuals referred to the medical services program and provide ongoing case management services to disabled children (recipients) eligible under the Katie Beckett Eligibility Option as determined by the Division of Welfare and Supportive Services.
A Health Care Coordinator III-RN functions as a team leader: coordinates reviews; assists in training staff; reviews complex care cases; serves as primary assistant to the supervisor; provides technical assistance with assigned programs; acts as part of the office management team in identifying trends and potential solutions to problems and issues; makes decisions and appropriately responds to situations.
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.
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.