Nurse

Reporttexasfraud; Austin (TX); On-site; USD 85,000 - 90,000; Full time

Job summary

Texas HHS Office of Inspector General is seeking a Nurse Specialist for evaluating Medicaid Nursing Facilities. The candidate will be responsible for clinical reviews, policy development, and maintaining relationships with various stakeholders. This full-time position requires nursing experience and the ability to work independently.

Benefits

Medical insurance

Vision insurance

401(k)

Qualifications

• Licensed to practice as a Registered Nurse in Texas.
• RAC-CT certification required or to be obtained within 3 months.
• Experience in nursing facility administration or utilization review.

Responsibilities

• Conduct advanced clinical review and consultative work for Medicaid Nursing Facilities.
• Evaluate medical records and perform reconsideration reviews.
• Develop policies and training materials; provide staff education.

Skills

Communication

Analytical skills

Interpersonal skills

Education

Graduation from an accredited school of professional nursing

Tools

Microsoft Word

Microsoft Excel

Job description

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Texas HHS Office of Inspector General provided pay range

This range is provided by Texas HHS Office of Inspector General . Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

We are seeking a dedicated Nurse Specialist to join our team. This role involves working with Medicaid Nursing Facilities (NF), focusing on reconsideration and corrective action processes. The ideal candidate will have experience in nursing and an understanding of healthcare regulations and the utilization of the RAI manual. This individual will need to be RAC-CT certified or willing to obtain certification within three months of the start date.

Job Description:

The Nurse III performs advanced clinical review and consultative work for the Surveillance Utilization Review (SUR) division within the Office of Inspector General. Work performed in this position includes nursing work in reconsideration and corrective action processes for Medicaid Nursing Facilities (NFs). The nurse reviewer uses advanced program knowledge and nursing expertise to evaluate medical records and perform reconsideration reviews when the original review has resulted in a change to the NF’s Minimum Data Set (MDS) assessment and ensures state rules, regulations, and written policies and procedures are applied. This position assists with the planning, development, and implementation of policies, procedures, and training materials; provides SUR staff with ongoing education; establishes and maintains effective working relationships and communication with HHS staff and other agencies and organizations; appropriately interacts with NFs and provides timely responses to requests and inquiries. The nurse reviewer coordinates special projects as needed; and performs other duties as assigned to maintain efficient agency operations. This position works under minimal supervision of the director of SUR with extensive latitude and use of initiative and independent judgment.

Essential Job Functions:

• (50%) Uses technical and analytical skills review and evaluation of medical records submitted by NFs for reconsideration.
• (25%) Uses advanced nursing knowledge to ensure that reconsideration and corrective action processes for NFs are consistently applied according to rules, regulations, and written policies and procedures. Promptly identifies inconsistencies and makes recommendations to management for action.
• (15%) Assists with the planning, developing, and implementing of policies, procedures, and training materials and provides NFs and SUR staff with ongoing education.
• (5%) Establishes and maintains effective working relationships and communication with HHS staff and other agencies and organizations; appropriately interacts with NFs and provides timely responses to requests and inquiries.
• (5%) Performs other duties as assigned and keeps manager informed as necessary.

Registrations, Licensure Requirements or Certifications:

• Licensed to practice as a Registered Nurse in the State of Texas or in a state recognized under the Compact Licensure Agreement.
• Applicant must be Resident Assessment Coordinator - Certified (RAC-CT) or be willing to obtain certification within three (3) months of start date.
• License is current and in good standing.

Knowledge Skills Abilities:

• Knowledge of federal and state laws governing Medicaid policies and procedures and long-term care facilities. Knowledge of resident assessment instrument, MDS items and form completion.
• Knowledge of medical diagnoses, procedures and accepted medical treatment patterns.
• Knowledge of or ability to apply methods of analysis, detection, and measurement of fraud, waste, and abuse.
• Skill in communicating effectively, verbally and in writing.
• Skill in establishing and maintaining effective working relationships.
• Ability to apply nursing knowledge, practices, and procedures to components of job and in consultation; particularly the ability to interpret medical documents, including charts, narratives, plans of treatment and diagnosis.
• Ability to interpret and apply policies, procedures and regulations.
• Ability to develop and/or revise policies and procedures.
• Ability to use personal computers and related software.
• Ability to work under limited supervision.
• Ability to plan, prioritize and coordinate work in an independent manner.
• Ability to work well under pressure with limited time restraints.
• Ability to travel 15% of time, with potential of some overnight stays required.

Initial Screening Criteria:

• Graduation from an accredited school of professional nursing, college, or university is required.
• Full time experience in nursing facility administration or utilization review required.
• Experience using personal computers and Microsoft applications such as Microsoft Word and Microsoft Excel required.
• Prefer knowledge of MDS

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Administrative

• Industries

  Public Policy Offices and Medical Practices

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

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