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Job Description
Announcement Number: 51167 Open to all qualified persons. Posted 04/15/2025 Close Date: 04/22/2025 Recruiter:
ANA MARIA ORNELLAS
Phone: (775)684-0151
Email: aornellas@admin.nv.gov Applications accepted for another 4 Days 13 Hrs 28 Mins
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.
This opening is for a Health Care Coordinator 3 - Nurse within the Division of Health Care Financing and Policy Long Term Services and Supports (LTSS) unit and will be located in Reno. 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. ***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 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. 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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ABOUT THE COMPANY
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STATE OF NEVADA
Show moreThe presence of Nevada's earliest inhabitants, beginning about 12,400 years ago, is marked by many petroglyphs and archaeological sites. Baskets, decoys, and ingenious traps are evidence of the resourcefulness of these early people in a harsh and arid environment.
European explorers traveled through Nevada in the early 19th century, but it was not until 1851 that the first settlements were established. An Act of Congress created the Territory of Nevada on March 2, 1861. James W. Nye of New York was appointed Nevada's first Territorial Governor by President Abraham Lincoln later that year. On October 31, 1864, President Lincoln proclaimed Nevada's admission to the Union as the 36th state. The State's first elected Governor, Henry Blasdel, took office on December 5, 1864.
Today, Nevada is the nation's seventh largest state in land area. Several hundred mountain ranges cross its landscape, many with elevations over 10,000 feet. In contrast, the State's lowest point (along the Colorado River) is only 470 feet above sea level. From majestic mountains to desert valleys, nature has endowed Nevada with diverse and unique ecosystems.
The Nevada Legislature has honored the State's natural resources and cultural heritage with a variety of State designations described below.
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