NURSE EVALUATOR IV, HEALTH SERVICES

Department of Health Care Services; New York (NY); Sur place; USD 110 000 - 140 000; Plein temps

Avantages offerts par ce poste

Continuous and ongoing training

Diversity, Equity, and Inclusion

Employee Assistance Program (EAP)

Résumé du poste

The Department of Health Care Services (DHCS) seeks a Nurse Evaluator IV to lead a multidisciplinary team within the Clinical Assurance Division. You will oversee Designated Public Hospitals and DRG TAR-Free post-paid claims, ensuring medical necessity and Medi-Cal policy compliance.

This senior role requires broad clinical expertise and Medi-Cal program knowledge, with duties spanning complex administrative, supervisory, and daily management tasks while aligning with state regulations and

Qualifications

• Broad clinical knowledge and Medi-Cal program knowledge.
• Experience supervising multidisciplinary teams.

Responsabilités

• Oversee compliance reviews of Designated Public Hospitals (DPH) and DRG hospitals.
• Manage TAR-Free post-paid claims and ensure medical necessity compliance with Medi-Cal policies.

Description du poste

Job Description and Duties

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.

About this 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 700within 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.

Special Note

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 .

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

Required Application Package Documents

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account atAll Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is optional. It may be included, but is not required.
• 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.

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/leaveDefined retirement programSavings Plus Program (401(k), 457)Medical/Dependent Care Reimbursement Accounts

Full benefits information can be found on CalHR'sprovides more information about our commitment to serving Californians and organizational excellence.

Contact Information

The Hiring Unit Contact is available to answer questions regarding the position or application process.

Hiring Unit Contact:Lani SuPlease 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

California Relay Service: (TTY), (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 andGovernment 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.