Job Summary

Texas Health and Human Services is seeking candidates for a position of Nurse III on Full Time basis located at San Antonio, TX. Do not forget to review the job posting carefully before apply online.

Job Title:	Nurse III
Company Name:	Texas Health and Human Services
Job Location:	San Antonio, TX
Job Type:	Full Time
Job Category:	Government Administration
Job Link Expiry:	2023-04-15
Posted on:	Jobstri.xyz

Job Details:

About the job

Job Description

The Nurse Reviewer plans and conducts reviews and investigations, prepares reports and makes appropriate notification for the Office of Inspector Utilization Review Unit. Works under limited supervision with considerable latitude for the use of initiative and independent judgment. Conducts utilization reviews for Medicaid recipients in Medicaid approved hospitals to determine accuracy of the diagnosis and procedure coding, to ensure accurate payment and to review the quality of care provided. Conducts MDS assessment and reimbursement reviews in Medicaid approved nursing facilities to determine the accuracy of assessment data provided by the nursing facility to ensure accurate payment. Performs other duties as assigned and required to maintain unit operations. The Nurse Reviewer lifts up to 40 pounds, walks extended distances and travels approximately 50% of the time.

Essential Job Functions

Conducts hospital and nursing facility medical investigations and reviews to determine accuracy of data (10%). Conducts investigations and examinations of alleged violations of laws, rules and regulations regarding fraud in Medicaid coding (5%). Conducts utilization reviews on Medicaid recipients in Medicaid approved hospitals to determine necessity of admission and the accuracy of diagnosis and procedural coding (40%). Conducts MDS assessment reviews in Medicaid approved nursing facilities (40%). Demonstrates interpersonal skills to facilitate a team approach (5%).

Knowledge Skills Abilities

Knowledge of case review, analysis evaluation, detailed case documentation, defining problems and making appropriate decisions. Knowledge of federal and state Medicaid policies and procedures. Knowledge of medical diagnosis, procedures and accepted medical treatment patterns. Skill in interviewing techniques, organization of work and multiple tasks. Skill in communicating effectively, orally and in writing. Skill in establishing and maintaining effective working relationships. Able to work under pressure, perform work under general supervision. Able to maintain a professional attitude. Able to conduct fraud and abuse investigations. Ability to travel extensively (up to 50%) with some overnight travel required

Registration Or Licensure Requirements

Licensed to practice as a Registered Nurse in the State of Texas or in a state recognized under the Compact Licensure Agreement. License is current and in good standing.

Initial Selection Criteria

Completed application with detailed work history, two years full-time experience as a practicing Registered Nurse in both skilled nursing facilities and/or hospitals highly preferred.

Current licensure in good standing. Graduation from an accredited school of professional nursing, college or university is required.

Ability to travel 50% of the time. Prior knowledge and work history

Additional Information

Interview process includes work-related exercise. Upon final selection and contingent offer, candidate must provide a certified copy of a college transcript and submit to criminal history background verification. The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual Chapter 7. In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview. Note: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include: 68C, 66N/P/W, 290X, 46FX, 46NX, 46SX. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.

MOS Code

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include: 68C, 66N/P/W, 290X, 46FX, 46NX, 46SX. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx

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I-9 Form – Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.