Health Care Coordinator 2

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

This position is with the Department of Nevada Health Authority (NVHA) and is located at the Las Vegas District Office. This position requires less than fifty percent of time travelling within the Las Vegas District Office catchment area. Health Care Coordinators (HCCs) 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 and participate in program development. This position will also assist walk-ins in the District Office lobbies to provide the member information regarding benefits and to troubleshoot complicated access to care issues.

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 one year of professional experience providing case management services in a social or health related field; OR one year of experience as a Health Care Coordinator I in Nevada State service; 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 direction incumbents perform the full range of duties described in the series 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.

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.

Working knowledge of: theories principles practices and methods of social work nursing or a health care profession applicable to the program assignment; case management practices applicable to the program assignment; interviewing techniques; crisis intervention techniques; assessment tools used to evaluate clients; normal and abnormal human growth behavior and development.

General knowledge of: federal regulations and State laws applicable to the program assignment; anatomy physiology pharmacology and psychology; medical and pharmaceutical terminology; services roles and responsibilities of social service agencies; impact of diseases and disabilities on individuals.

Ability to: manage a caseload of individuals with significant physiological developmental emotional and psychological problems and related disorders; determine initial and ongoing ability to meet the criteria for pertinent agency programs; read and interpret program regulations and policies; access and verify information using computer equipment and records; analyze health and social information to determine risk factors client needs and functional level; monitor and evaluate services provided; research review and interpret medical records and make recommendations; develop and implement plans of care including authorizing services as appropriate; document case activities and write reports; provide instruction and direction to clients and others in group or individual settings.

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.