Nurse II Position

4 weeks ago

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

The Texas Department of Aging & Disability Services is seeking a highly skilled Nurse II to join our team. As a key member of our Utilization Review team, you will play a critical role in ensuring the delivery of quality, cost-effective services to Texans.

Job Summary:

The Nurse II will be responsible for reviewing and evaluating individual service plans, patient assessments, and documentation related to Medicaid services. You will conduct face-to-face interviews with individuals enrolled in various programs, including Community Attendant Services, Home and Community-based Services, and Texas Home Living. Your expertise will be used to determine service justification, appropriateness, and quality of services, as well as make service authorization decisions.

Key Responsibilities:
  • Conduct desk reviews of required documentation for Health and Human Services Commission, Medicaid Long Term Care Waiver Programs, and Community Attendant Services.
  • 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, and determine appropriateness, quality, and cost-effectiveness of services.
  • Make service authorization decisions on difficult, complicated, and/or targeted cases.
  • Conduct a variety of quality assurance reviews and quality improvement studies and evaluate compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures.
  • Work collaboratively with other UR nurses through routine and ad hoc meetings to implement an effective statewide UR program and ensure UR policies and procedures are applied consistently.
  • Develop, provide resources, and technical assistance to regional staff and providers.
  • Testify as the Subject Matter Expert (SME) in Medicaid fair hearings related to appealed service reductions or denials.
  • Produce routine and specialized data and information for program reports.
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.

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