Nurse Evaluator III: Lead, Post-Payment Claims

California Department of Health Care Services; California; A distancia; USD 86.000 - 114.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Continuous training

DEI program activities

Employee Assistance Program (EAP)

Descripción de la vacante

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.

Formación

• NURSE EVALUATOR III, HEALTH SERVICES

Responsabilidades

• 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.

Descripción del empleo

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.