Salary: $47,711 - $70,741 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 become familiar with Medicaid policies and procedures and receive training in the duties described above. This is the entry level in the series and progression to the journey level may occur upon successful completion of the probationary period, meeting the minimum qualifications, and with the recommendations of the appointing authority. The Health Care Coordinator I -RN serves within the Division of Health Care Financing and Policy (DHCFP) of the Department of Health and Human Services. The incumbent of this position's duties will fall primarily under the Facility Outreach and Community Integration Services (FOCIS) unit located at the Las Vegas Medicaid District Office. FOCIS is a program created by the State of Nevada in response to the Federal Olmstead Decision. This mandate requires that individuals residing in nursing facilities, hospitals, or rehabilitation centers, be given the opportunity to explore resources as an alternative to living within an institution. Health Care Coordinators, within this unit, perform professional work related to Medicaid program operations which includes research, assessment, and care plan development in compliance with program policies and regulations. Health Care Coordinators are out in the field, meeting with recipients, or within travel up to 50%. DHCFP provides a supportive and team based atmosphere that encourages flexibility and creative collaboration. It is our goal to provide quality health care services to low-income Nevadans in the most efficient, equitable, and cost containing manner possible. To be a part of this progressive and innovative team, apply today!
Announcement Number: 36999
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.