Nurse III
4 weeks ago
Under the general supervision of the Utilization Review (UR) High Needs Quality Assurance Manager, the High Needs UR Nurse III is responsible for the evaluation of long term services and supports (LTSS) activities for High Needs individuals enrolled in the following programs: STAR Kids, STAR+PLUS, Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), and Deaf Blind with Multiple Disability (DBMD) including but not limited to clinical review of medical records, assessments, planning documents and other relevant documentation for validation of service needs and service delivery; consultation and development of recommendations on individual cases involving service appropriateness; and determination of compliance with policies, procedures, rules, laws, contract standards, and correctness of needs assessments for Medicaid managed care LTSS.
If you are looking for an opportunity to use both considerable clinical experience and highly developed research and critical thinking skills, this job may be perfect for you.
Essential Job Functions:
Conducts reviews on all high needs cases including: individuals transitioning out of STAR Kids, General Revenue (GR), Money Follows the Person Limited Nursing Facility Stay for the Medically Dependent Children Program (MDCP), and any other requests, as assigned with a focus on nursing interventions, treatments and service delivery. (30%)
Determines compliance and provides MCO oversight of nursing activities, medical records, assessments including medical necessity/level of care (MN/LOC), STAR Kids-Screening and Assessment Instrument (SK-SAI) and ISPs for accuracy. Standards of care, and quality of service. Makes recommendations for improvements as a result of reviews. (15%)
Determines compliance with Medicaid program service requirements, state rules, regulations, policies and procedures for individuals with diagnoses of Intellectual and Developmental Disability (IDD) to validate service needs and service provision, determine appropriateness, quality, and cost effectiveness of services being authorized on an individual’s plan of care. (15%)
Works collaboratively with colleagues through routine and ad hoc meetings to ensure utilization review policies and procedures are applied consistently (5%).
Develops, provides resources and technical assistance related to high needs transitions, to the agency staff, managed care organizations, IDD waiver community provider base, advocacy groups, external stakeholders, program participants and their families. (15%)
Testifies as the subject matter expert in Medicaid fair hearings related to appealed service reductions or denials for IDD high needs transition cases. (10%)
Researches and responds to legislative inquiries related to High Needs Cases.(5%)
Participates in special projects upon request (5%).
Knowledge Skills Abilities:
Knowledge of Texas Medicaid policy related to clinical services and service delivery as detailed in the Uniform Managed Care Contract Manual and other applicable Medicaid contracts, STAR+PLUS, STAR Kids, and STAR Health handbooks, Texas Administrative Code, and the Texas Medicaid Provider Procedures Manual (TMPPM). Experience with utilization review in authorization of clinical services; case management; managed care utilization review principles and practices. Knowledge of Health and Human Service Commission programs including Medicaid/CHIP. Excellent computer skills, including Microsoft Office Suite. Ability to communicate effectively both orally and in writing. Demonstrated ability to work independently and function effectively as a member of a team, and under tight deadlines with high volume workloads. Highly organized, and the ability to manage several projects concurrently in a fast-paced environment and juggle competing priorities. Detail and task-oriented. Highly proficient in the English language with excellent written, verbal, and interpersonal communication and presentation skills. Ability to actively participate in meetings and workgroups. Skilled in establishing and maintaining effective working relationships with managers, coworkers, and other staff or program stakeholders. Knowledge of quality assurance and improvement measures and principles. Familiarity with ICD-10 and HCPC/CPT codes.
-
Advanced Vocational Nurse III
2 weeks ago
Austin, Texas, United States Texas Department of Aging & Disability Services Full timeBecome a Vital Member of Our Healthcare Team as an Advanced Vocational Nurse IIIThe Texas Department of Aging & Disability Services is seeking an Advanced Vocational Nurse III to join a dynamic group of healthcare professionals dedicated to providing exceptional clinical care to individuals with diverse needs.In this role, you will work alongside a committed...
-
Licensed Vocational Nurse III
3 months ago
Austin, United States Texas Department of Aging & Disability Services Full timeJob Description: The Austin State Supported Living Center (AUSSLC) is seeking a Licensed Vocational Nurse III to join an interdisciplinary team of professionals to provide clinical care to individuals of the AUSSLC. As a State Supported Living Licensed Vocational Nurse III, you will work at the AUSSLC campus with a dynamic group of staff and professionals...
-
Registered Nurse III
3 weeks ago
austin, United States Texas A&M International University Full timeRegistered Nurse IIIJob Title Registered Nurse III Agency Texas A&M International University Department Student Health Services Proposed Minimum Salary $5,331.75 monthly Job Location Laredo, Texas Job Type Staff Job Description Job Summary The Registered Nurse III, under general supervision, provides patient care, evaluations, and treatment....
-
Psychiatric Nursing Asst III
5 months ago
Austin, United States Texas Department of Aging & Disability Services Full timeJob Description: Would you thrive in an environment where you learn and grow personally and professionally all while helping make a positive impact on people’s lives? Do you appreciate being around others like yourself who are dependable, trustworthy, hard workers who believe in the value of each other, teamwork, and inclusivity? HSCS is dedicated to...
-
Director III
2 months ago
Austin, United States Texas Department of Aging & Disability Services Full timeJob Description: The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Utilization Review (UR) Intellectual and Developmental Disabilities (IDD) Waiver and Community Services (WCS) Director III. MCS is driven by its mission to deliver quality, cost-effective...
-
Licensed Vocational Nurse III
5 days ago
Austin, Texas, United States Texas Department of Aging & Disability Services Full timeJob Summary:The Texas Department of Aging & Disability Services is seeking a highly skilled Licensed Vocational Nurse III to join our interdisciplinary team of professionals. As a Licensed Vocational Nurse III, you will provide advanced senior level vocational nursing work, providing care, treatment, and general welfare of individuals with intellectual and...
-
Registered Nurse III
2 weeks ago
Austin, TX, United States Texas A&M International University Full timeRegistered Nurse III Job Title Registered Nurse III Agency Texas A&M International University Department Student Health Services Proposed Minimum Salary $5,331.75 monthly Job Location Laredo, Texas Job Type Staff Job Description Job Summary The Registered Nurse III, under general supervision, provides patient care, evaluations, and treatment....
-
Travel Nurse RN: Explore New Horizons
1 week ago
Austin, Texas, United States Travel Nurse Source Full timeAbout the PositionWe are seeking a skilled CVICU RN to join our team at Travel Nurse Source, partnering with American Medical Staffing to provide high-quality care in Texas.Benefits of Travel NursingDevelop your patient advocacy skills in diverse healthcare settings.Enhance your knowledge of holistic patient care by exploring alternative medicine...
-
Travel Nurse RN
1 week ago
Austin, Texas, United States Travel Nurse Source Full timeAbout the PositionWe are seeking a qualified PCU RN to join our team at Travel Nurse Source, working in partnership with American Medical Staffing. This is a fantastic opportunity to take your career to the next level and experience the rewards of travel nursing.Job RequirementsCurrent ACLS certificationCurrent BLS certificationCore Mandatory Part I...
-
Travel Nurse RN
5 days ago
Austin, United States Travel Nurse Source Full timeTravelNurseSource is working with Amare Medical Network to find a qualified Admin/Mgmt RN in Austin, Texas, 78704! About The Position Nursing supervisors provide a critical link between hospital management and clinical care, overseeing patient-care operations, assigning and monitoring staff nurses, and identifying and implementing quality improvements....
-
Cardiovascular Intensive Care Unit Registered Nurse
14 hours ago
Austin, Texas, United States Travel Nurse Source Full timeJob Title: Cardiovascular Intensive Care Unit Registered NurseJob Summary:We are seeking a highly skilled and experienced Cardiovascular Intensive Care Unit Registered Nurse (CVICU RN) to join our team at Travel Nurse Source. As a CVICU RN, you will be responsible for providing comprehensive care to critically ill patients with primary cardiac...
-
Clinical Utilization Review Nurse III
2 weeks ago
Austin, Texas, United States Texas Department of Aging & Disability Services Full timeJob Overview: The position of Nurse III is available with opportunities for telecommuting. The work environment is adaptable and not confined to specific locations. As a Senior Managed Care Nurse Analyst, you will play a pivotal role within the Acute Care Utilization Review Unit, reporting directly to the Managed Care Clinical Review Manager. This role is...
-
Austin, Texas, United States Travel Nurse Source Full timeJob SummaryWe are seeking a highly skilled Cardiovascular Intensive Care Unit Registered Nurse to join our team at Travel Nurse Source. As a CVICU RN, you will be responsible for providing comprehensive care to critically ill patients with primary cardiac diagnoses.Key ResponsibilitiesPerform intense monitoring of patients and care for those requiring...
-
Clinical Services Manager III
4 days ago
Austin, Texas, United States The State of Oklahoma Full timeJob SummaryThis is a challenging and rewarding opportunity to join The State of Oklahoma as a Registered Nurse III. As a key member of our healthcare team, you will be responsible for providing direct care services at county health departments, with a focus on quality improvement efforts and management of community health initiatives.Key...
-
Nurse III
1 week ago
Austin, Texas, United States Texas Health & Human Services Commission Full timeJob SummaryThe Texas Health & Human Services Commission is seeking a highly skilled and experienced Nurse III to join our team as a Managed Care Clinical Review Specialist. This is a senior-level position that requires a strong clinical background, excellent analytical and communication skills, and the ability to work effectively in a fast-paced...
-
Travel Nurse RN
15 hours ago
Austin, Texas, United States Travel Nurse Source Full timeJob SummaryTravel Nurse Source is partnering with American Medical Staffing to find a qualified ER/Trauma RN for a contract position in Austin, Texas.About the PositionWe understand that choosing the right career path can be overwhelming, with numerous calls, emails, and messages from medical staffing agencies. At Travel Nurse Source, we offer a different...
-
Nurse III
7 days ago
Austin, Texas, United States Texas Health & Human Services Commission Full timeJob SummaryThe Texas Health & Human Services Commission is seeking a highly skilled Nurse III - Managed Care Clinical Review Specialist to join our team. As a key member of our Acute Care Utilization Review Unit, you will play a critical role in ensuring compliance with Texas Medicaid contracts and state and federal regulations.Key ResponsibilitiesConduct...
-
Registered Nurse III
1 month ago
Austin, TX, United States Texas A&M International University Full timeRegistered Nurse IIIJob Title Registered Nurse III Agency Texas A&M International University Department Student Health Services Proposed Minimum Salary $5,331.75 monthly Job Location Laredo, Texas Job Type Staff Job Description Job Summary The Registered Nurse III, under general supervision, provides patient care, evaluations, and treatment....
-
NICU Director Level III RN
1 month ago
Austin, United States St. David's North Austin Medical Center Full timeDescription This position is incentive eligible. IntroductionWe are seeking a(an) NICU Director Level III RN with St. David's North Austin Medical Center to promote growth and unlock possibilities. At HCA Healthcare, we are committed to the care and improvement of human life. Share your leadership skills and come make a difference...
-
NICU Director Level III RN
4 weeks ago
Austin, United States St. David's North Austin Medical Center Full timeDescription This position is incentive eligible. IntroductionWe are seeking a(an) NICU Director Level III RN with St. David's North Austin Medical Center to promote growth and unlock possibilities. At HCA Healthcare, we are committed to the care and improvement of human life. Share your leadership skills and come make a difference...
