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About the Role

The Nurse III, Waiver Eligibility, conducts reviews of assessments and other relevant documentation to make determinations of eligibility for Medicaid waiver programs. This role involves reviewing additional information from various sources to supplement existing assessments and integrates knowledge of Medicaid/CHIP programs with current healthcare practices. The position reports to the Medical Director for Waiver Eligibility and involves complex clinical and consultative work with considerable latitude for initiative and independent judgment.

Responsibilities

Performs review of assessments and associated documentation for determination of waiver eligibility.
Interprets complex state and federal laws, regulations, and rules related to the program.
Responsible for timely and accurate reporting of results.
Represents unit at fair hearings and administrative reviews as needed.
Reviews documentation generated internally and submitted from external sources as part of proceedings.
Partners with internal and external clients to increase program effectiveness.
Recommends areas for improvement as a result of the review process.
Attends work on a regular and predictable schedule.
Performs other duties as assigned.

Requirements

Requires a current license to practice as a Registered Nurse (RN) in the State of Texas (or a state that recognizes reciprocity through the Nurse Licensure Compact).
At least three years work experience as an RN in a health agency, hospital, or healthcare facility.
At least one year of clinical nursing experience with pediatric populations.
Bachelor of Science in Nursing or Master of Science in Nursing is preferred.
At least one year experience with utilization review and/or utilization management is preferred.
At least one year experience with long-term services and supports is preferred.
At least one year experience with adult and geriatric populations is preferred.
Must bring I-9 documentation on the first day of work.

Skills

Organizing work.
Care and treatment of patients, including the use of diagnostic and treatment tools and equipment.
Written and verbal communication necessary to provide clear and concise determinations and reports.
Establishing and maintaining productive working relationships both internally and externally.
Identify appropriate nursing care and other health care services.
Prepare, maintain, and present reports.
Explain and interpret applicable health laws, rules, standards, and regulations.
Understand and effectively interpret agency and program rules, policies, and procedures.
Use a personal computer, fax machine and copier, telephone conferencing functions, and components of the Microsoft Office Suite and Outlook email.
Gather, assemble, correlate, and analyze facts.
Devise solutions to problems.
Develop and evaluate policies and procedures.
Perform policy and medical literature research.
Communicate effectively orally and in writing.
Interact effectively and professionally with people from diverse cultural, socioeconomic, educational, racial, ethnic, and professional backgrounds.
Nursing principles, techniques, and procedures.
Health care laws, rules, standards, and regulations.
Medical diagnoses and procedures, accepted medical treatments, and nursing care principles, practices, and procedures.
Medicaid and managed care regulations and procedures.
Health care needs and services for pediatric and adult clients with special needs.

Location

AUSTIN

Work Type

Full time
Telework eligible

Experience Level

Senior-level
Three years work experience as an RN
One year of clinical nursing experience with pediatric populations
One year experience with utilization review and/or utilization management
One year experience with long-term services and supports
One year experience with adult and geriatric populations

Education Level

Bachelor of Science in Nursing or Master of Science in Nursing preferred

Salary/Compensations

$5,425.33 - $7,000.00 Monthly

Benefits

100% paid employee health insurance for full-time eligible employees
Defined benefit pension plan
Generous time off benefits
Numerous opportunities for career advancement

About the Company

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans.
At HHSC, your contributions matter, and we support you at each stage of your life and work journey.
Medicaid and CHIP Services (MCS) is driven by its mission to deliver quality, cost-effective services to Texans.
The Office of the Medical Director (OMD) provides clinical consultation and guidance to other areas within MCS, throughout the Agency, and to external stakeholder organizations.
OMD works to provide a clinical vision for improving the health of Texans by aligning MCS programs with state public health priorities.
OMD also leads the utilization review team of MCS which is charged with ensuring that individuals receive medically necessary, cost-effective services.

Equal Opportunity

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability.
All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position.