HEALTH CARE COORDINATOR 2 - NURSE

Announcement Number: 50250 Open to all qualified persons. Posted 01/27/2025 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 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 opening is for a Health Care Coordinator 2 - Nurse within the Division of Health Care Financing and Policy District Office, in Las Vegas. Health Care Coordinators in this position use multiple databases to research recipient data, eligibility information, and computer system interface issues. This position accepts Care Coordination cases and Serious Occurrence Follow-up cases. Duties include assisting Medicaid recipients in accessing their healthcare and assessing their needs to prevent further serious occurrences. As a licensed Registered Nurse, employee may be assigned or brought in for consultation on cases where the Medicaid recipient has multiple or complex medical needs; requires out-of-state care, treatment or procedure; requires a transition in or out of state to a step-down facility; may require multiple specialists for treatment; requires a specialized or compound medication; needs specialty care transport or transportation to and from facilities arranged. This position performs outreach to the general public, providers, community agencies, groups and organizations regarding Medicaid functions, policies, and services in the rural and urban communities covered by the Las Vegas District Office. They may attend meetings in the community and speak to groups and individuals; attend health fairs and respond to inquiries and concerns from clients and the general public. ***THIS RECRUITMENT MAY CLOSE WITHOUT FURTHER NOTICE DEPENDING ON THE NUMBER OF APPLICATIONS RECEIVED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE***

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 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. 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
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Email Direct Inquiries or Correspondence to: Division of Human Resource Management
Northern Nevada
515 East Musser Street,
First Floor
Carson City, Nevada 89701-4204

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• STATE OF NEVADA

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