NURSE EVALUATOR II, HEALTH SERVICES

State of California; Sacramento (CA); Remote; USD 83,000 - 109,000; Full time

Job summary

Nurse Evaluator II (NE II) at the State of California’s Department of Health Care Services performs professional nursing duties as part of the medical review team, including utilization review and TAR adjudication to ensure Medi-Cal services meet medical necessity and policy requirements.

Travel statewide up to 5% for meetings and outreach; this permanent, full‑time position offers telework options and comprehensive state benefits. Final Filing Date: Until Filled.

Qualifications

• Professional nursing duties as part of the medical review team.
• Review of patient histories and medical records.
• Prepare draft reports and responses for fair hearings.
• Provide guidance to providers, beneficiaries, and other Department and government staff on medical policies and procedures.

Responsibilities

• Perform utilization review to ensure medical necessity and policy compliance for Medi-Cal services.
• Conduct post-claims oversight and TAR adjudication.
• Review medical records and patient histories to inform determinations.
• Prepare documentation and responses for fair hearings and inquiries.

Job description

Nurse Evaluator II (NURSE EVALUATOR II, HEALTH SERVICES)

$7,430.00 - $9,757.00 per Month. New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.

Final Filing Date: Until Filled

About this Role: Under direction of the Nurse Evaluator III in the Department of Health Care Services' (DHCS) Clinical Assurance Division (CAD), the Nurse Evaluator II (NE II) performs professional nursing duties as part of the medical review team, including utilization review, post-claims oversight, and adjudication of Treatment Authorization Requests (TARs) to ensure services provided to Medi-Cal beneficiaries meet medical necessity and comply with Medi-Cal policy. The NE II reviews patient histories and medical records, prepares draft reports and responses for fair hearings, and provides guidance to providers, beneficiaries, and other Department and government staff on medical policies and procedures.

Travel statewide, including overnight, of up to 5% of the time, by airplane, train, automobile, and other transportation methods is required to perform job related tasks such as attend meetings and conduct provider outreach. Travel related duties are dependent upon workload and operational need.

If you already have list eligibility for this classification, you do not need to retake the examination, except when your list eligibility expires.

Conflict of Interest Code: This position is designated under the Conflict of Interest Code. The position is responsible for making or participating in the making of governmental decisions that may potentially have a material effect on personal financial interests. The appointee is required to complete Form 700 within 30 days of appointment and once per year. Failure to comply with the Conflict of Interest Code requirements may void the appointment.

# of Positions

Multiple

Work Location

United States

Telework

Telework

Job Type

Permanent, Full Time

Department Information

DHCS’ purpose is to provide equitable access to quality health care leading to a healthy California for all.

DHCS is a dynamic organization with ambitious goals and talented, committed employees. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians. DHCS is committed to addressing disparities within our organization and in our communities through efforts toward greater diversity, equity, and inclusion. This is accomplished, in part, by a commitment toward employing a diverse workforce that reflects the many communities we serve, and by promoting and enforcing equal employment opportunity.

Reasonable Accommodations

Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting.

Company Culture

DHCS is dedicated to creating an innovative workplace for its team members that is inclusive, diverse, and interactive! Here are a few of the ways we stay engaged with our team:

• Continuous and ongoing training
• Diversity, Equity, and Inclusion program activities
• Employee Assistance Program (EAP)

Additionally, as a team member of the State of California, you may be eligible for many benefits, such as:

• Medical, including health, dental, and vision insurance.
• Paid Holidays and vacation/leave
• Defined retirement program
• Savings Plus Program (401(k), 457)
• Medical/Dependent Care Reimbursement Accounts

Contact Information

Hiring Unit Contact:
Lani Su
[phone]
[e-mail]

EEO Contact:
EEO Officer
[phone]
[e-mail]

California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

Telework and Salary Information

Telework: This position is currently eligible for telework. The amount of telework is at the discretion of the Department and is subject to change consistent with DHCS’ Telework Program and Government Code sections 14200 – 14203. Telework is available to California residents, and proof of residency may be required.

Business travel may be required, and reimbursement considers an employee’s designated office and residence subject to regulations and bargaining unit contract provisions. All commute expenses to the reporting location will be the responsibility of the selected candidate.

Personal Leave Program 2025 Agreement

Personal Leave Program 2025 agreement

Salary: Effective July 1, 2025, the California Department ofHuman Resources (CalHR) implemented the temporaryPersonal Leave Program 2025 (PLP 2025). PLP 2025directs that each employee receive a temporary reductionin pay in exchange for PLP 2025 leave credits. The

temporary salary reduction percentage and the number ofPLP 2025 leave credits are based on the position’sassociated bargaining unit. The salary range(s) included inthis job advertisement do not include the temporary salaryreduction. Please reach out to the hiring unit contact listedon this job advertisement for details.

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug‑free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.