Health Care Coordinator - Nurse

It includes assessing the level of care needed to safely maintain the home environment and guiding families on services provided through Nevada Medicaid. The role requires home visits to evaluate the child’s needs in the home, conducted at least annually, and involves some travel. This position may also participate in auditing skilled nursing facilities using the Minimum Data Set, with certification in this process potentially required within the first year.

Health Care Coordinator - Nurses perform work related to program operations and auditing providers to ensure compliance with program regulations and policies.

Essential Qualifications

One or more years of applicable experience as described in the job duties and Licensure as a Registered Nurse issued by the Nevada State Board of Nursing.

Job Duties

Assess potential client needs for case management services. Develop, implement, and update plans of care. Counsel and refer clients to services and/or contract with providers for services.

Monitor the quality and cost of services provided and submit payment authorization requests. Establish and maintain case files. Review facilities, provide care to validate, and ensure adequacy of services and resident care.

Review information, document findings and deficiencies, prepare reports, and participate in conferences. Review health care providers and fiscal agents for compliance. Ensure clients are receiving appropriate services and payment is correct for services received.

Identify areas needing improvement and review plans of correction. Process payment requests to ensure medical necessity and compliance and approve or deny requests. Review records from the applicable parties, identify abuse and potential fraud, and ensure proper payment.

Refer errors to the fiscal agent for adjustment and refer potential cases of fraud and abuse for investigation. Explain billing procedures, monitor quality of care, and submit billings to the fiscal agent for payment. Perform related duties as assigned.

Knowledge, Skills, and Abilities

Knowledge of

Applicable federal and State laws, regulations, and agency policies and procedures; theories, principles, practices, and methods of social work, nursing, or a health care field applicable to program assignment; dynamics of human behavior including interpersonal relationships and social interactions; client rights and confidentiality of information; interviewing techniques; crisis intervention techniques; case management practices. Physical, psychological, and social characteristics associated with human development and the population served; assessment tools used to evaluate clients; normal and abnormal human growth, behavior, and development; anatomy, physiology, pharmacology, and psychology; medical and pharmaceutical terminology; services, roles, and responsibilities of social service agencies; impact of diseases and disabilities on individuals. Service programs and provider responsibilities relative to the program assignment; licensing regulations of various living arrangements; functions and costs of rehabilitative and assistive medical equipment related to the program assignment; agency hearing processes and protocols.

Skill in

Interpersonal and communication, both verbal and written. Use and operation of office and job-related equipment and software.

Ability to

Provide technical assistance regarding policy compliance and coverage; forecast the cost of medical services, equipment, and supplies; monitor the cost effectiveness of services for each individual client; develop and modify case plans, procedures, and methods to maximize services and effect change in clients; visually observe the general condition of the population served and assist in verifying the level of care needed and received; audit contractors and review corrective action plans; navigate, locate, and enter data into the agency’s computer systems; recognize basic medical and social needs. Effectively interact with people of various social, cultural, economic, and educational backgrounds; communicate effectively to obtain information, explain policies and procedures, and persuade others to seek or accept needed services; analyze information, problems, and situations and reach logical conclusions; compose concise, logical, and grammatically correct correspondence, case narratives, and reports; read and understand technical materials; assemble, analyze, and report data.

Recruiter Contact Information: Jenn Trachet -

jtrachet@admin.nv.gov

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.

Please send direct Inquiries or correspondence to the recruiter listed on this announcement.