[Close] 

Health Care Coordinator 2 - Nurse

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 perform the full range of duties described above. In addition, incumbents at this level may intermittently serve as the project lead of a case management team, function as coordinator of a specifically assigned portion of a program, and assist in training other Health care Coordinators and providers. This is the journey level of the series.
This position is with the Department of Health and Human Services in the Division of Health Care Financing and Policy (DHCFP) and is located at the Las Vegas District Office. This position requires up to fifty percent of time traveling within the Las Vegas District Office catchment area.Health Care Coordinators (HCC's) evaluate individuals referred to the medical services program and provide ongoing case management services to Medicaid eligible clients; evaluate the need for medical services, treatment, equipment and supplies and authorize payment; screen individuals to determine appropriate level of care in nursing homes; and review programs and participate in programs and participate in program development. This position would also conduct provider reviews and/or site visits to evaluate for compliance of state and federal regulations or for provider enrollment requirements and report findings within short time constraints to contribute to the health, safety, and welfare of Medicaid recipients. The incumbent will obtain and maintain American Association of Nurse Assessment Coordinators (AANAC) certification to complete Minimum Data Set (MDS) reviews in long term care facilities.
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 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. Special Requirements 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. This position requires the incumbent to travel over a wide geographic area, either by motor vehicle or air travel, including commuter planes. Travel at least 50% of the time is required.



Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.

More Jobs

HEALTH CARE COORDINATOR 2 - NURSE
Reno, NV State of Nevada
HEALTH CARE COORDINATOR 2 - NURSE
Las Vegas, NV State of Nevada
Health Care Coordinator 2 - Nurse
Indian Springs, NV State of Nevada
Health Care Coordinator 2 - Nurse
Sparks, NV State of Nevada
Health Care Coordinator 2 - Nurse
Reno, NV State of Nevada