Senior Nurse Evaluator IV (Telework Eligible)

Department of Health Care Services; New York (NY); Presencial; USD 110.000 - 140.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Continuous and ongoing training

Diversity, Equity, and Inclusion

Employee Assistance Program (EAP)

Descripción de la vacante

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

Formación

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

Responsabilidades

• 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.

Descripción del empleo

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