HEALTH CARE COORDINATOR 3 - NURSE - Carson City or Reno APPROXIMATE ANNUAL SALARY - $70,282.08 to $104,713.20 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. JOB INFORMATION Work Type: Permanent, full time vacancies as they may occur Statewide. Department: Health and Human Services (http://dhhs.nv.gov/) Division: Health Care Financing & Policy Job Class Code: 12.333 RECRUITMENT INFORMATION Announcement Number: 47866 Open to all qualified persons. Posted 06/21/2024 Recruiter: ANA MARIA ORNELLAS Phone: (775)684-0151 Email: aornellas@admin.nv.gov Applications accepted until recruitment needs are satisfied ** Qualified individuals are encouraged to apply immediately. Lists of eligible candidates will be established and hiring may occur early in the recruiting process. Recruitment will close without notice when a sufficient number of applications are received or a hiring decision has been made. The Position 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 opening is for a Health Care Coordinator 3-Nurse within the Division of Health Care Financing and Policy (DHCFP) Long Term Services and Supports (LTSS) unit, and may be located in Carson City or Reno NV. The Health Care Coordinator (HCC) Nurse position serves as the clinical expert for the LTSS unit. This includes evaluating medical records to determine medical necessity for a variety of LTSS Medicaid services, including appropriateness for out of state placements. The HCC Nurse also is the dedicated clinical reviewer for eligibility determinations for the Behaviorally Complex Care Program in Nursing Facilities and participates in the Fair Hearing process related to clinical decisions. In addition to medical necessity assessments, the HCC Nurse position serves as a consultant to policy and procedure updates for Home Health, Private Duty Nursing, Hospice, Nursing Facilities and Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities. Heavy use of the Microsoft family of desktop software programs (Outlook, Word, Excel) is necessary to fulfill the positions requirements. Occasional travel may be required. Nevada offers sunshine and recreational opportunities including golfing, biking, off-roading, hiking, skiing, and fishing. Nevada's landscape and economy are a few reasons to join the Silver State workforce! Additional benefits include: medical, dental, life and disability insurance programs; participation in the public employees' retirement plan; 12 paid holidays; and accrual of 3 weeks of annual and 3 weeks of sick leave each year. The State of Nevada is committed to Equal Employment Opportunity/Affirmative Action in recruitment of its employees and does not discriminate on the basis of race, color, national origin, religion or belief, age, disability, sex, sexual orientation, gender identity or expression, pregnancy, domestic partnership, genetic information (GINA), or compensation and/or wages. To see full Class Specifications visit: http://hr.nv.gov/Resources/ClassSpecs/Class\_Specifications-12\_0/ To Qualify: 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. Special Requirements 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. The Examination 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. INFORMATIONAL LINKS For more information about state employment, visit the following: Division of Human Resource Management: http://hr.nv.gov Public Employees Retirement System: http://www.nvpers.org Public Employees Benefits Program: https://pebp.nv.gov/ More Benefits Information: http://nvjobs.nv.gov/Applicants/EB REFER A FRIEND Help us reach qualified candidates! Refer a friend by clicking here: Email Direct Inquiries or Correspondence to: Division of Human Resource Management Northern Nevada 515 East Musser Street, First Floor Carson City, Nevada 89701-4204TDD for the Hearing Impaired (800) 326-6868 Division of Human Resource Management Southern Nevada 7251 Amigo St, Suite 120 Las Vegas, NV 89119TDD for the Hearing Impaired (800) 326-6868 To begin the application process, click on the Apply button. Click Cancel to return to the previous page.