Nurse Evaluator IV

California Department of Health Care Services; California (MO); Remote; USD 93,000 - 125,000; Full time

Benefits offered by this job

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

Job summary

California Department of Health Care Services seeks a Nurse Evaluator IV to manage the TAR-based utilization review process for Medi-Cal services. This role oversees a multidisciplinary staff and ensures decisions meet medical criteria and state policies, with travel for meetings and training.

The position emphasizes extensive clinical knowledge, Medi-Cal program understanding, and the ability to apply least-cost methods while maintaining consistency across TAR determinations.

Qualifications

• Minimum qualification: Nurse Evaluator IV, Health Services.
• Broad clinical knowledge and Medi-Cal program familiarity.
• Ability to manage TAR-based utilization reviews and supervise staff.

Responsibilities

• Manage the TAR utilization review process for Medi-Cal services.
• Oversee TAR decisions with clinical criteria and professional judgment.
• Ensure TAR decisions are consistent with Medi-Cal policies and regulations.
• Travel to attend meetings and conduct provider/staff training.

Job description

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, as well as through collaboration with the federal government and other state agencies, counties, and partners, in caring for low-income families, children, pregnant women, older adults, and individuals with disabilities. This is an exciting opportunity to join our diverse team.

About this Role:

The Nurse Evaluator IV (NE IV) is responsible for a wide variety of complex administrative, supervisory, and day-to-day management tasks for a multidisciplinary staff in the Clinical Assurance Division (CAD). The incumbent will be charged specifically with managing the utilization review process for services requested by Medi-Cal providers on a Treatment Authorization Request (TAR) form. TARs and supporting documentation are reviewed and adjudicated based on broad medical criteria and professional judgment by a staff of Nurse Evaluators and Medical Consultants. The NE IV oversees the authorization of medically necessary services to Medi-Cal eligible fee-for-service beneficiaries using the least costly alternative to meet their medical needs. The incumbent will ensure that TAR decisions are consistent and that Medi-Cal policies and regulations are uniformly applied. This position requires a broad spectrum of clinical knowledge and experience as well as Medi-Cal program knowledge. Travels to attend meetings and/or conduct provider/staff training.

This position is designated under the Conflict of Interest Code. The position is responsible for making or participating in the making of government 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 a bi-weekly basis. The cutoff dates will be: September 17, 2026, September 30, 2026, October 15, 2026, October 30, 2026, November 12, 2026, November 26, 2026, December 17, 2026, December 31, 2026, January 14, 2027, January 28, 2027, February 11, 2027, and February 25, 2027.

Special Note: Temporary Authorization Appointment (TAU) appointments may be considered for this vacancy, and such appointments may become permanent provided the selected candidate obtains a reachable rank on the associated examination. Please see below "Who May Apply" section for more information.

You will find additional information about the job in the Duty Statement.

Working Conditions

Please see the Telework and Salary Information section below for telework, reporting location, and temporary statewide salary reduction details.

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

• NURSE EVALUATOR IV, HEALTH SERVICES

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details

Job Code #: JC-530058

Position #(s): 805-200-8149-XXX

Working Title: Nurse Evaluator IV

Classification: NURSE EVALUATOR IV, HEALTH SERVICES

$8,373.00 - $11,182.00

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 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.

Who May Apply

Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply. Temporary Appointments may be considered if conditions warrant. Temporary Appointments may be made to anyone regardless of eligibility. Temporary Appointments may not exceed 9 months and will require eligibility to be obtained through an examination process in order to transition to a permanent appointment.

Applicants will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).

Benefits

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

• 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.

Contact Information

Hiring Unit Contact:

Lani Su

[phone]

[e-mail]

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

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.

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

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.

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 workplace. 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.