Health Care Coordinator 4

***THIS RECRUITMENT MAY CLOSE WITHOUT FURTHER NOTICE DEPENDING ON THE NUMBER OF APPLICATIONS RECEIVED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE***

This Health Care Coordinator IV supervisor position is under the direction of the Nevada Health Authority Division of Nevada Medcaid and is located in the Las Vegas District Office. This position is responsible for supervising subordinate Health Care Coordinators including the hiring evaluating performance and administering disciplinary action. Plans and organizes unit operations; develops procedures and guidelines; coordinates staff activities; evaluates the quality and quantity of the work performed; prepares reports and recommendations to management; plans arranges and trains staff members; participates in community and public relations; assists with budgetary recommendations such as staffing travel and program needs. This position supervises case management services to disabled children (recipients) eligible under the Katie Beckett Eligibility Option as determined by the Division of Social Services.

Health Care Coordinators perform professional work related to program operations and auditing providers to ensure compliance with program policies and regulations. They evaluate individuals referred to the medical services program and provide ongoing case management services to Medicaid eligible clients; evaluate the need for medical services treatment equipment and supplies and authorize payment; screen individuals to determine appropriate level of care in nursing homes; review programs to ensure services are being provided in a cost effective manner; participate in program development by providing input on policies and procedures forms medical coverage and system enhancements.

Licensure as a Social Worker or professional licensure or certification in a medical specialty applicable to the assignment and three years of experience providing case management services in a social or health related field one year of which included the interpretation and application of Medicaid policies and procedures coordinating reviews and services training staff and reviewing complex cases; OR licensure and an equivalent combination of education and experience.

Assess potential client needs for case management services using assessment tools to identify social service and/or medical needs; develop and implement plans of care for those determined to be eligible for services; counsel and refer clients to services and/or contract with providers for services; maintain contact with clients through home visits and telephone calls; monitor the quality and cost of services provided to clients; periodically update plans of care; submit payment authorization requests; and maintain case files.

Participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of services and resident care; ensure reimbursement matches the cost of services provided; monitor nursing facility quality indicator reports; screen and assess Medicaid clients regarding discharge to community-based care; review medical records; document findings and deficiencies on appropriate forms; prepare reports of findings and participate in exit conferences; participate in independent professional reviews of providers to determine the quality of care compliance with patient rights and appropriateness of placement as assigned.

Review health care providers and fiscal agents to ensure clients are receiving appropriate services and payment is correct for services received; ensure providers and fiscal agents are in compliance with division policies and procedures; ensure employee health certification and training needs are appropriate and properly documented in personnel records; verify client records have appropriate documentation and that authorized services correlate with services provided; confirm termination of services were appropriately documented and mandated reporting requirements were met; provide technical assistance regarding policies and procedures; complete written documentation using appropriate format; identify areas needing improvement and review plans of correction.

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 pertinent medical information and previous requests; evaluate medical necessity to justify payment by comparing the diagnosis and other medical information with the request; refer requests to a medical consultant for another medical opinion as necessary; render determinations in accordance with Medicaid policy and notify providers of decisions.

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; refer financial errors to the fiscal agent for adjustment of charges and refer potential cases of fraud and abuse for further investigation.

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.

Perform related duties as assigned.

Under general direction incumbents supervise positions in the Health Care Coordinator and Health Care Coordinator Nurse classes other journey level professional and support personnel including hiring evaluating performance and administering disciplinary action. Incumbents plan and organize unit operations; develop procedures and guidelines; coordinate staff activities; evaluate the quality and quantity of work performed; prepare reports and recommendations to management; plan arrange and/or provide training to staff members and providers; participate in community and public relations activities as assigned and assist with budgetary recommendations such as staffing travel and program needs. Incumbents may be assigned to oversee a single program unit or a variety of programs and they may be working supervisors who also perform the duties described above.

This job specification lists the major knowledge skills and abilities of the job and is not all inclusive. Incumbent(s) will be expected to have knowledge skills and abilities from a previous level.

Detailed knowledge of: federal regulations State laws and agency directives applicable to the program assignment; mission goals and objectives of the division; agency policies and procedures.

Working knowledge of:system interface between all division programs.

General knowledge of: basic principles of training and supervision; data collection techniques; principles of budgeting.

Ability to:prepare and present verbal and written reports; recruit and train staff; delegate and assign work to subordinates; evaluate employee performance and provide constructive feedback; mediate and negotiate between contending parties; establish program and staff goals and objectives; determine appropriate training and equipment needs of assigned personnel; facilitate staff meetings.

Recruiter Contact Information: Victoria Sheehan -

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.