HEALTH CARE COORDINATOR 3 - NURSE
: Job Details :

The PositionHealth 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: