Nurse Evaluator III

California Department of Health Care Services; California; À distance; USD 86 000 - 114 000; Plein temps

Avantages offerts par ce poste

Continuous training

DEI program activities

Employee Assistance Program (EAP)

Résumé du poste

California Department of Health Care Services (DHCS) is seeking a Nurse Evaluator III to supervise a unit responsible for post-payment hospital claims reviews, TAR adjudication, and drafting state fair hearing documents. The NE III will mentor staff, provide clinical consultations, and ensure all outputs meet Medi-Cal and regulatory standards.

The role requires leadership in post-payment reviews and adherence to department policies, with telework options and a salary range listed in the posting.

Qualifications

• NURSE EVALUATOR III, HEALTH SERVICES

Responsabilités

• Supervise a unit of Nurse Evaluators responsible for post-payment hospital claims reviews and TAR adjudication.
• Draft state fair hearing documents and participate in assigned state fair hearings.
• Provide clinical consultations and mentor staff; ensure all work products meet Medi-Cal and state/federal guidelines.
• Serve as lead on assigned post-payment claims reviews and ensure compliance with policies.

Description du poste

Job Description And Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role.

About this Role

Under direction of the Supervisor II, the Nurse Evaluator (NE) III supervises a unit of Nurse Evaluators responsible for performing post-payment hospital cliams reviews, adjudication of Treatment Authorization Requests (TARs), drafting state fair hearing documents, and participating in assigned state fair hearings. The NE III is responsible for training and mentoring staff, providing clinical consultations, and ensuring all work products meet Medi-Cal guidelines, division policies, and state and federal regulations, guidelines, and procedures. The NE III also serves as lead on assigned post-payment claims reviews.

New to state candidates will be hired into the minimum salary of the classification or minimum of the alternate salary range when applicable. Placement to alternate range may be based on education or experience identified in your state application.

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.

This recruitment is until filled and applications will be reviewed on the following cutoff dates: September 18, 2026, October 2, 2026, October 16, 2026, October 30, 2026, November 13, 2026, November 27, 2026, December 11, 2026, December 28, 2026, January 15, 2027, January 29, 2027, February 12, 2027, and February 26, 2027.

Minimum Requirements

• NURSE EVALUATOR III, HEALTH SERVICES

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details

Job Code #: JC-530672

Position #: 805-200-8145-XXX

Working Title: Nurse Evaluator III

Classification: NURSE EVALUATOR III, HEALTH SERVICES

Salary: $7,674.00 - $10,249.00

New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.

# 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.

Desirable Qualifications

• Ability to move/lift/carry/reach material which may weigh up to 25 pounds.
• Ability to use modern office technology, tools and equipment (e.g., cell phones, computer and other IT equipment)
• Ability to work in a fast-paced environment, able to multi-task, set priorities, and meet deadlines.
• Customer service oriented, demonstrates professional customer service skills, and strong interpersonal skills.
• Demonstrates a positive attitude, flexibility, and dependability in all workplace activities.
• Demonstrates excellent attendance and punctuality.
• Remain in a stationary position for extended periods of time.
• Ability to work in a noisy environment.
• Available to work from 7:00 a.m. to 5:30 p.m., Monday through Friday, in office as scheduled and as needed.
• Ability to travel for work meetings and mandatory trainings.

Benefits

• 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

Full benefits information can be found on CalHR's California State Civil Service Employee Benefits Summary.

DHCS 2023-2027 Strategic Plan provides more information about our commitment to serving Californians and organizational excellence.

We need your help! Please let us know how you heard about our position by taking this brief optional survey: SurveyMonkey link.

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 Information 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.

The DHCS office location for this position may be located in West Sacramento, San Francisco, San Bernardino, San Diego and Los Angeles.

For a list of possible DHCS office assignment locations, please reference the reporting location document attached to the duty statement on this job advertisement.

Personal Leave Program (PLP) 2025 Agreement

Salary: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. Please reach out to the hiring unit contact listed on this job advertisement for details.

Additional Information

Using the online application system as specified in the announcement is the preferred method of applying for civil service job opportunities; however, applicants may instead apply by way of U.S. mail, parcel delivery or courier service, or in person, as set forth in this announcement.

Paper applications must include a signature. Dates printed on envelopes by mobile barcodes or equivalent mobile print technology are not acceptable proof of the date the application and any other required documents or materials were filed.

Applicants must state their basis of eligibility (List Eligibility, Lateral Transfer, Reinstatement, T&D, or Surplus/SROA), and the Job Control (JC) number and/or position number in the “Examination(s) or Job Title(s), For Which You Are Applying” section on the STD. 678. Surplus/SROA candidates should submit a copy of their letter with their application. Please remove any confidential information (i.e., social security number, date of birth, etc.) as well as any information regarding your LEAP eligibility and/or exam scores from your documents prior to submission.

All information on the Employment Application (STD 678) must be completed. Applicants should include all employment history on the Employment Application (STD 678), including detailed job descriptions, hours worked per week, and start/end dates (MM/DD/YYYY). Resumes or other documents may not be substituted for the Employment Application (STD 678).

If applying electronically, please note that CalCareers no longer allows applicants to withdraw their applications. If you need assistance to withdraw your application, please contact the Recruitment Section at [e-mail]. For all other questions regarding your CalCareer account, please contact CalHR’s CalCareers Unit at [phone] or [e-mail].

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.