NURSE EVALUATOR IV, HEALTH SERVICES

State of California; California (MO); Hybrid; USD 93,000 - 125,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Paid holidays and vacation

Defined retirement program

Savings Plus Program 401(k, 457)

Dependent Care Reimbursement Accounts

Job summary

The State of California invites applications for Nurse Evaluator IV in Health Services. You will oversee multidisciplinary staff, manage DPH and DRG TAR-free post-paid claims, and ensure medical necessity alignment with Medi-Cal policies.

This is a senior leadership role requiring clinical knowledge and strong program understanding. Telework option is available; permanent/full-time positions may be located in multiple DHCS office locations, with salary transparency, and a commitment to equity

Qualifications

• Leadership and management experience overseeing, training, planning and directing the workload of nurses.
• Ability to provide clear, concise, and effective written documentation and oral presentation.
• Ability to develop and maintain cooperative working relationships with internal and external customers.

Responsibilities

• Oversee compliance reviews of DPH and DRG hospitals utilization management to ensure policy-aligned practice.
• Supervise multidisciplinary staff and manage day-to-day administrative tasks.
• Ensure Medi-Cal policy compliance and program procedures in Hospital utilization management.

Skills

Leadership

Written communication

Interpersonal skills

Adaptability

Team leadership

Customer service

Organizational skills

Job description

Nurse Evaluator IV
NURSE EVALUATOR IV, HEALTH SERVICES

$8,373.00 - $11,182.00 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

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 in the following role.

Under the direction of the Manager II, Branch Chief, 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 have oversight with managing the Designated Public Hospitals (DPH) and Diagnosis Related Group (DRG) Treatment Authorization Request (TAR)-Free post-paid claims. The NE IV oversees compliance reviews of DPH and DRG hospitals utilization management determined by medical necessity to ensure hospital compliance with Medi-Cal policy, regulations, and program procedures. This position requires a board spectrum of clinical knowledge and experience as well as Medi-Cal program knowledge.

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 advertisement is posted as until filled. Applications will be reviewed: 10/2/2026, 10/23/26, 11/6/2026, 11/20/2026, 12/4/2026, 12/18/2026, 1/4/2027, 1/28/27, 2/12/27, 2/26/27, and 3/12/2027.

SIMPLE 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

# 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.

Take a look at some of DHCS' recent projects and happenings that our Department has accomplished in the DHCS Newsroom.

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.

Desirable Qualifications

• Management and leadership experience overseeing, training, planning and directing the workload of nurses.
• Ability to provide clear, concise, and effective written documentation and oral presentation.
• Ability to develop and maintain cooperative working relationships, and deal tactfully, professionally, and confidentially with all internal and external customers and contacts.
• Ability to adapt behavior and work methods in response to new information, changing conditions or unexpected obstacles.
• Ability to take initiative, and work both independently and in a team environment.
• Demonstrated ability to lead and motivate staff and provide high-quality customer service in a positive work environment.
• Strong organizational and interpersonal skills.

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

We need your help! Please let us know how you heard about our position by taking this brief optional survey: SurveyMonkey link . This survey is not required to be considered for this position.

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.

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 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.