HEALTH CARE COORDINATOR 2

State of Nevada; Las Vegas (NV); Presencial; USD 60.000 - 75.000; Jornada completa

Descripción de la vacante

The Aging and Disability Services Division (ADSD) in Las Vegas, Nevada seeks a Health Care Coordinator II to support HCBS and FOCIS/MFP programs. Responsibilities include case management, assessments, eligibility, and care planning for Medicaid clients with travel up to 35%.

Two career tracks are described: coordination of community resources and oversight of provider services with documentation in an electronic system. A valid driver’s license is required.

Formación

• 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.

Responsabilidades

• Assess potential client needs for case management services and develop plans of care for eligible clients.
• Counsel and refer clients to services and contract with providers for services.
• Maintain contact with clients through home visits and calls; monitor service quality and cost.
• Review facilities and ensure proper reimbursement and quality of care; document findings for reports.

Conocimientos

Case management

Assessment

Documentation

Communication

Descripción del empleo

• No Nevada state income tax.

Job Summary

The Aging and Disability Services Division (ADSD) is currently recruiting for a Health Care Coordinator 2 in Las Vegas, Nevada. This recruitment may be used to fill current and future vacancies as they occur in the following programs: Home & Community Base Services- Supportive Services (HCBS) and Facility Outreach and Community Integration Services/Money Follows the Person (FOCIS/MFP). Positions assigned to the HCBS - Supportive Services program ensure a coordinated support system to meet the needs of at-risk elderly and persons with a disability by providing case management and essential services to recipients of HCBS - Supportive Services programs statewide to facilitate community integration and avoid institutionalization. Responsibilities include case management, assessment, eligibility determination, development, implementation, and oversight of the plan of care, home visits and documentation utilizing a web-based case management software system. Positions assigned to the Facility Outreach and Community Integration Services (FOCIS) ensure a coordinated support system to meet the needs of at-risk Nevadans by connecting and facilitating community resources for recipients to avoid institutionalization. Responsibilities include care coordination, assessments, home/facility visits, and documentation utilizing an electronic system of record keeping. ADSD fosters a positive, inclusive, and diverse work environment that values innovation, teamwork, and collaboration. The mission of ADSD is to empower individuals and their support systems by providing resources for disabilities and aging - connecting Nevadans to services and improving their quality of life.

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.

Essential Qualifications

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.

Job Duties

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.

This position requires travel up to 35% of the time.

A valid driver's license is required at the time of appointment and as a condition of continuing employment.

Under direction, incumbents perform the full range of duties described in the series concept. In 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.

Knowledge, Skills, And Abilities

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.

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.

Benefits Include

• Health Insurance: Medical, dental, life, and disability insurance programs for employees and their dependents/family are offered through the Public Employees’ Benefits Program (PEBP).


• Vacation: Accrual of three weeks of annual leave each year.


• Sick Leave: Accrual of three weeks of sick leave each year.


• Holidays: 12 paid holidays per year.


• Retirement: Participation in the Nevada Public Employees Retirement System (PERS). Employees do not contribute to Social Security but will contribute to PERS if their position is at 50% or more full-time equivalency. For more information on how PERS service may impact Social Security benefits, visit the SSA publication.


• Deferred Compensation: The State offers a voluntary Deferred Compensation Program.


• No Nevada state income tax.


• Public Service Loan Forgiveness: Eligible due to public sector employment.


• Longevity Payments Eligibility: Employees who have received a performance rating of “standard” or better and have completed eight (8) or more years of continuous service are eligible for longevity pay.

Additional benefits

may apply to employees covered under a Collective Bargaining Agreement (CBA), depending on their designated bargaining unit. For more information, visit the Labor Relations Unit (LRU).

For more details about your rights and responsibilities as a State of Nevada employee, please review the State of Nevada Employee Handbook (PDF).

State Holidays The holiday schedule for State employees is established by the Legislature.

The Following Are Legal Holidays

January 1.............................................. New Year's Day

Third Monday in January.................. Martin Luther King, Jr.'s Birthday

Third Monday in February................ Washington’s Birthday

Last Monday in May........................... Memorial Day

June 19................................................ Juneteenth Day

July 4.................................................... Independence Day

First Monday in September.............. Labor Day

Last Friday in October....................... Nevada Day

November 11........................................ Veterans' Day

Fourth Thursday in November........ Thanksgiving Day

Friday following the Fourth Thursday in November...................... Family Day

December 25........................................ Christmas Day

When January 1, June 19, July 4, November 11, or December 25 falls on a Saturday, the preceding Friday is the observed legal holiday. If these days fall on Sunday, the following Monday is the observed holiday. Eligibility for holiday pay is covered by the provisions of NAC 284.255