Salary: $52,033 - $77,402 per yr
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. Division of Health Care, Finance & Policy (DHCFP) in the Las Vegas District Office of Nevada Medicaid is looking for a Health Care Coordinator II, RN with case management experience to apply to the management of children cared for in the home on the Katie Beckett Eligibility Option. This position would oversee, assist with case support and assistance navigating the Medicaid services of children with medically fragile or with intellectual disabilities being cared for in the home. Assessment of the level of care needed to safely maintain the home environment and assistance with the services available within the Medicaid provisions for Nevada. This position would also involve home visits for assessment of the child in the home environment at a minimum annually. Travel up to 50% of the time may be required. This position would also involve the audit process for skilled nursing facilities of the Minimum Data Set. Attainment of certification of this process would be necessary within the first year. Nevada offers sunshine and recreational opportunities including golfing, biking, off-roading, hiking, skiing, and fishing. Nevada's landscape and economy are a few reasons to join the Silver State workforce! Additional benefits include: medical, dental, life and disability insurance programs; participation in the public employees' retirement plan; 11 paid holidays; and accrual of 3 weeks of annual and 3 weeks of sick leave each year. DHCFP is committed to Equal Employment Opportunity/Affirmative Action in recruitment of its employees and does not discriminate on the basis of race, color, national origin, religion or belief, age, disability, sex, sexual orientation, pregnancy, genetic information (GINA), or gender identity and expression.
Announcement Number: 36320
Open to all qualified persons.
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.