Nurse Evaluator II

3 days ago

West Sacramento, California, United States State of California, Department of Health Care Services Full time

Under direction of the Staff Services Manager II (SSM II), the Nurse Evaluator II applies medical knowledge to monitor and evaluate provider claiming patterns, monitor implementation and performance of medical policy in the claims processing system, and recommended appropriated action based on the facts obtained. Assists in the development and implementation of new or revised Medi-Cal and Public Health Medical Policy. Prepares reports for management review and approval. The incumbent must possess professional nursing experience, a high degree of initiative, independent and critical thinking, written and oral communication skills, workload prioritization, and time management skills; attention to detail and follow-through is imperative.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

  • Ability to engage team effectively.
  • Ability to develop and maintain effective and cooperative working relationships.
  • Ability to easily adapt to changing priorities.
  • Knowledge of Medi-Cal policy and regulations.
  • Familiarity with the Health Care Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding – from both the State of California and Federal Medicaid perspectives.
  • Familiarity with the Health Insurance Portability and Accountability Act (HIPAA) – from both the State of California and Federal perspectives.
  • Ability to communicate with and bridge relationships among medical, non-technical program and technical staff related to system development projects.
  • Confidence to interact with senior-level and high-level entities in medical/technical fields.

Have questions and/or need assistance?

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For more details and to apply, please use the link below:

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Job Type: Full-time

Pay: $7, $9,757.00 per month

Benefits:

  • 401(k)
  • Caregiver leave
  • Dental insurance
  • Family leave
  • Flexible spending account
  • Health insurance
  • Paid holidays
  • Paid time off
  • Parental leave
  • Partner benefits
  • Professional development assistance
  • Retirement plan
  • Vision insurance

Work Location: Hybrid remote in West Sacramento, CA 95605

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