Nurse II Position

3 hours ago


Arlington, Virginia, United States Texas Department of Aging & Disability Services Full time
Job Title: Nurse II

Join the Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department as a highly qualified Nurse II. This role is a critical part of our mission to deliver quality, cost-effective services to Texans.

Job Summary:

We are seeking a skilled Nurse II to ensure individuals served in our (c) waiver programs and Community Attendant Services (CAS) receive the appropriate type and amount of service. The ideal candidate thrives in an environment that emphasizes teamwork, excellence, and personal accountability.

Key Responsibilities:
  • Reviews and evaluates individual's records, individual service plans (ISPs), patient assessments, and documentation related to Title XIX and Title XX.
  • Conducts face-to-face interviews with individuals enrolled in various programs to determine service justification.
  • Uses program knowledge and nursing expertise to determine appropriateness and quality of services, cost-effectiveness of the service plan, and validates determinations of health service needs.
  • Makes service authorization decisions on difficult, complicated, and/or targeted cases.
  • Conducts quality assurance reviews and quality improvement studies to evaluate compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures.
Requirements:
  • Meets the criteria for designation as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations.
  • Knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health and nursing care principles, quality management, utilization management, health care needs and services for elderly and disabled.
  • Thorough knowledge of ID and other developmental disability-related conditions, HCS, TxHmL, CLASS, DBMD, CAS, and ICF/ID program rules, service array and billing guidelines, local authority functions, and waiver service system.
  • Ability to communicate effectively, both orally and in writing, and interpret statistical information.
  • Ability to multi-task, handle stress, and meet deadlines.
Working Conditions:

This position works collaboratively with other UR nurses and regional staff to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently.

This position works under the general supervision of the UR Nurse Manager, with moderate latitude for use of initiative and independent judgment.


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