Nurse Evaluator II Position

1 week ago


Sacramento, California, United States State of California Full time
Job Summary

The State of California is seeking a highly skilled Nurse Evaluator II to provide clinical and professional support for the Department of Managed Health Care (DMHC). This role is responsible for assisting consumers with health care issues and ensuring that managed health care enrollees receive the medical care and services to which they are entitled.

Key Responsibilities
  • Provide clinical and professional support for all offices of the Help Center, including the Contact Center, Independent Medical Review Branch, Standard Complaint Branch, Provider Complaint Unit, and Legal Affairs Branch.
  • Support staff on issues related to consumer/enrollee health care complaints filed with the DMHC pursuant to the Knox-Keene Health Care Service Plan Act of 1975 and Title 28 of the California Code of Regulations.
  • Review, research, and/or gather clinical information to determine or affirm the appropriate handling of a consumer/enrollee complaint by contacting consumers/enrollees, their representatives, and/or health plans.
  • Implement and ensure compliance with the Department's Strategic Business Plan goals.
Requirements
  • Valid License to Practice as a RN in California.
  • Ability to evaluate situations accurately and take effective action.
  • Excellent communication and analytical skills.
  • Ability to work in a hybrid telework model.
Benefits

The State of California offers a comprehensive benefits package, including medical, dental, and vision insurance, retirement plans, and paid time off.

This is a permanent, full-time position with a salary range of $7,214.00 - $9,473.00.


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