Nurse II Specialist

4 weeks ago

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

We are seeking a highly skilled Nurse II to join our team at the Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department. As a key member of our team, you will play a critical role in ensuring individuals served in our waiver programs and Community Attendant Services (CAS) receive the appropriate type and amount of service.

Key Responsibilities:
  • Conduct desk reviews of required documentation for Health and Human Services Commission (HHSC), Medicaid Long Term Care Waiver Programs and Community Attendant Services (CAS).
  • Participate in onsite, televideo, or telephonic interviews of individuals identified in the random sample.
  • Review, evaluate, and document services provided to aged and disabled persons and persons with intellectual disability to validate service needs, service provision, determines appropriateness, quality, and cost effectiveness of services.
  • Makes service authorization decisions on difficult, complicated, and/or targeted cases.
  • Conduct a variety of quality assurance reviews and quality improvement studies and evaluates compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures.
  • Works collaboratively with other UR nurses through routine and ad hoc meetings to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently.
  • Develops, provides resources and technical assistance to regional staff and providers.
  • Testifies as the Subject Matter Expert (SME) in Medicaid fair hearings related to appealed service reductions or denials.
  • Produces routine and specialized data and information for program reports.
  • Works collaboratively across MCS to identify innovative and effective solutions for clients and staff.
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.
  • Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports.
  • Awareness of federal and state laws relating to long term care and other Medicaid and non-Medicaid services and programs.
  • Knowledge of program planning, implementation and evaluation, and continuous quality improvement.
  • Ability to communicate effectively, both orally and in writing.
  • Ability to interpret statistical information.
  • Ability to multi-task, handle stress and meet deadlines.
  • Ability to work collaboratively across MCS to accomplish objectives.
  • A keen attention to detail and the ability to implement creative solutions to problems.
  • Able to balance team and individual responsibilities.
  • Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports.
Working Conditions:

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

The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

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