<p>The Position</p> <p>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.</p> <p>This opening is for a Health Care Coordinator 3 - Nurse within the Division of Health Care Financing and Policy Long Term Services and Supports (LTSS) unit and will be located in Reno. The Health Care Coordinator (HCC) Nurse position serves as the clinical expert for the LTSS unit. This includes evaluating medical records to determine medical necessity for a variety of LTSS Medicaid services, including appropriateness for out of state placements. The HCC Nurse also is the dedicated clinical reviewer for eligibility determinations for the Behaviorally Complex Care Program in Nursing Facilities and participates in the Fair Hearing process related to clinical decisions. In addition to medical necessity assessments, the HCC Nurse position serves as a consultant to policy and procedure updates for Home Health, Private Duty Nursing, Hospice, Nursing Facilities and Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities. <em>THIS RECRUITMENT MAY CLOSE WITHOUT FURTHER NOTICE DEPENDING ON THE NUMBER OF APPLICATIONS RECEIVED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE</em></p> <p>To see full Class Specifications visit: http://hr.nv.gov/Resources/ClassSpecs/Class_Specifications-12_0/</p>