Nurse III
Location: Corpus Christi, Texas
Description: Health & Human Services Comm is in need of Nurse III right now, this position will be reside in Texas. More complete informations about this position opportunity kindly see the descriptions.
Nurse III Under the direct supervision of the UR Regional Manager, the utilization review (UR) nurse reviews and evaluates individuals records, individual service plans (ISPs), patient assessments, documentation related to Title XIX, Title XX, and state plan Medicaid community services for aged and disabled persons; along with conducting face to face interviews with waiver participants to determine service justification for individuals enrolling or enrolled in the Community Attendant Services (CAS), Deaf Blind and Multiple Disabilities Program (DBMD), Home and Community-Based Services (HCS), Texas Home Living (TxHmL) and Community Living Assistance Services and Supports waiver programs (CLASS). Based on these reviews and evaluation, the UR nurse uses program knowledge and nursing expertise to determine appropriateness, quality, and cost effectiveness and to make service authorization decisions about community services provided to aged and disabled persons and persons on IDD waiver programs. This position evaluates documented service provision activities and makes recommendations based on these findings when applicable. The UR nurse conducts desk reviews, on-site provider reviews, and face to face assessments to assess consumer s ervice needs, to validate determinations of health service needs, service provision, conducts a variety of quality assurance reviews, and quality improvement studies. The UR nurse will evaluate assigned Level of Need (LON) determinations in the IDD waiver programs when assigned to do so. This position works collaboratively with other UR nurses and regional staffs to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently. This position works under the general supervision of the UR Regional Manager, with moderate latitude for use of initiative and independent judgment.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Conducts desk reviews of required documentation for DADS Medicaid waiver programs and participates in onsite reviews of the individuals identified in the waiver random sample. Conducts desk and onsite reviews of those individuals aging out of the CCP program and the MDCP program with a focus on nursing interventions, treatments as well as those individuals assessed to need a higher percentage of nursing due to their medically fragile or compromised medical condition when a referral to do so is received. Reviews, evaluates, and documents Medicaid community services provided to aged and disabled persons and persons with intellectual disability to validate service needs and service provision, determine appropriateness, quality, and cost effectiveness of services. (35%) Makes service authorization decisions for program staff and providers on difficult, complicated, and/or targeted cases. (20%) Conducts a variety of quality assurance reviews and quality improvement studies and evaluates compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures. (15%) Works collaboratively with other UR nurses thro ugh routine and ad hoc meetings to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently. (10%) Develops, provides resources and technical assistance to regional staff and providers. (10%) Testifies as the subject matter expert (SME) in Medicaid fair hearings related to appealed service reductions or denials. (5%) Produces routine and specialized data and information for program reports. (5%
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Conducts desk reviews of required documentation for DADS Medicaid waiver programs and participates in onsite reviews of the individuals identified in the waiver random sample. Conducts desk and onsite reviews of those individuals aging out of the CCP program and the MDCP program with a focus on nursing interventions, treatments as well as those individuals assessed to need a higher percentage of nursing due to their medically fragile or compromised medical condition when a referral to do so is received. Reviews, evaluates, and documents Medicaid community services provided to aged and disabled persons and persons with intellectual disability to validate service needs and service provision, determine appropriateness, quality, and cost effectiveness of services. (35%) Makes service authorization decisions for program staff and providers on difficult, complicated, and/or targeted cases. (20%) Conducts a variety of quality assurance reviews and quality improvement studies and evaluates compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures. (15%) Works collaboratively with other UR nurses thro ugh routine and ad hoc meetings to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently. (10%) Develops, provides resources and technical assistance to regional staff and providers. (10%) Testifies as the subject matter expert (SME) in Medicaid fair hearings related to appealed service reductions or denials. (5%) Produces routine and specialized data and information for program reports. (5%
Knowledge Skills Abilities:
Must have one year’s experience in the provision of direct services to persons with an intellectual disability. Knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health and nursing care principles, quality management, utilization management, health care needs and services for elderly and disabled; Medicaid waiver program standards, policies, and procedures and government regulations and oversight me chanisms. Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports. Ability to: explain and interpret applicable health laws, rules, standards, and regulations; recognize patterns of medical necessity treatment, fraud, abuse, and neglect; use a personal computer, copier, Microsoft Office suite and Outlook e-mail; travel throughout the state as necessary. Must have a valid Texas Driving License and able to travel 75% of the time.
Must have one year’s experience in the provision of direct services to persons with an intellectual disability. Knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health and nursing care principles, quality management, utilization management, health care needs and services for elderly and disabled; Medicaid waiver program standards, policies, and procedures and government regulations and oversight me chanisms. Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports. Ability to: explain and interpret applicable health laws, rules, standards, and regulations; recognize patterns of medical necessity treatment, fraud, abuse, and neglect; use a personal computer, copier, Microsoft Office suite and Outlook e-mail; travel throughout the state as necessary. Must have a valid Texas Driving License and able to travel 75% of the time.
Registration or Licensure Requirements:
Registrations, Licensure Requirements or Certifications: Requirements or Certifications: Must be licensed as a professional nurse (RN) in the state of Texas or a state that recognizes reciprocity through the Nurse Licensure Compact. Must meet the federal definition of a Qualified Intellectual and Developmental Disability Professional.
Registrations, Licensure Requirements or Certifications: Requirements or Certifications: Must be licensed as a professional nurse (RN) in the state of Texas or a state that recognizes reciprocity through the Nurse Licensure Compact. Must meet the federal definition of a Qualified Intellectual and Developmental Disability Professional.
Initial Selection Criteria:
Experience in nursing work. Graduation from an accredited four-year college or university with major course work in nursing (BSN preferred), or from an accredited nursing program. Experience and education may be substituted for one another. Must have one year’s experience in the provision of direct services to persons with intellectual disability. Must have a valid Texas Driving License and able to travel 75% of the time. Ability to use a personal computer and related Microsoft Office software applications. Experience in utilization review and long term services and supports for the aged and disabled are highly desirable.
Experience in nursing work. Graduation from an accredited four-year college or university with major course work in nursing (BSN preferred), or from an accredited nursing program. Experience and education may be substituted for one another. Must have one year’s experience in the provision of direct services to persons with intellectual disability. Must have a valid Texas Driving License and able to travel 75% of the time. Ability to use a personal computer and related Microsoft Office software applications. Experience in utilization review and long term services and supports for the aged and disabled are highly desirable.
Additional Information:
Note: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to: 68C, 66N/P/W, 290X, 46FX, 46NX, 46SX. All active duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx. requisition 380145
Note: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to: 68C, 66N/P/W, 290X, 46FX, 46NX, 46SX. All active duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx. requisition 380145
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In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
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If you were eligible to this position, please deliver us your resume, with salary requ irements and a resume to Health & Human Services Comm.
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This position will be opened on: Fri, 04 May 2018 01:41:41 GMT
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