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Job Description
Announcement Number: 49384 Open to all qualified persons. Posted 10/22/2024 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 an Health Care Coordinator III-Nurse within the Division of Health Care Financing and Policy (DHCFP) District Office, in Las Vegas NV. The purpose of this position is to provide intensive behavioral health care coordination services to Nevada Medicaid recipients requiring significant or complex behavioral health services, whether inpatient or outpatient. This position would collaborate with other state and county government agencies, including carceral facilities, to locate appropriate services in Nevada, ideally in the recipient's current community setting where possible, and provide assistance on the authorization process, identifying and mitigating any barriers to access. This position will be utilizing the information provided by behavioral health care providers and service providers, parents, guardians, and advocates to help locate and procure appropriate behavioral health services in the community. The individual in this position must gather information and speak on behalf of DHCFP at times to explain services and eligibility criteria for behavioral health programs and services. This position must make judgement calls as to the urgency of matters and elicit assistance and support as needed based on nursing experience and behavioral health care and Medicaid services knowledge. The State of Nevada is an equal opportunity employer dedicated to building diverse, inclusive, and innovative work environments with employees who reflect our communities and enthusiastically serve them. All applicants are considered without regard to 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. ***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 pre-employment criminal history check and fingerprinting are required. 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. 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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