HEALTH CARE COORD III-NURSE
Location: , Nevada
Description: Nevada Employee Action and Timekeeping System is currently seeking to employ HEALTH CARE COORD III-NURSE right now, this vacancy will be reside in Nevada. More details about this vacancy opportunity please give attention to these descriptions. Health Care Coordinators perform professional work related to program operations and auditing providers to ensure compliance with program policies and regulat! ions. Assess potential client needs for case management services using assessment tools to identify social service and/or medical needs; participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of services and resident care. Review health care providers and fiscal agents to ensure clients are receiving appropriate services and payment is correct for services received, process payment authorization requests from providers to ensure the requested service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests. Review records from the fiscal agent, providers, clients and computer generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by the fiscal agent.
Explain proper billing procedures to contract providers selected by the client; monitor the quality of care given by the p! rovider to clients; and submit billings for services provided ! to the fiscal agent for payment. is located at the Office of the Attorney General, Las Vegas. The incumbent will function at the advanced journey level and must have a working knowledge of the following: conducting and documenting witness interviews; collecting, analyzing and interpreting records or other documents that would constitute evidence such as Resource Utilization Group (RUG) case mix scores, Minimum Data Set (MDS) patient assessment information, Prospective Payment System (PPS) tracking information, and both periodic and complaint investigation surveys. is responsible to review medical records to identify inconsistent diagnosis and treatments, upcoding, indication of falsification or forgery, and/or billing for services not rendered; attend autopsies or examine the physical condition of victims in order to collect and evaluate evidence to include cause of death, wound condition and care assessment, exposure, malnutrition and other conditions; review evidence and ! provide a determination of any departure from the conduct of an ordinarily prudent and careful person under the same circumstances, conduct contrary to the proper regard for danger to human life, or that constitutes indifference to the resulting consequences.
is responsible to compile evidence and prepare investigative reports for submission to the prosecutor, prepare for and provide expert testimony in courtroom hearings and grand jury proceedings. Medicad Fraud unit, nurse investigator. To see full Class Specifications visit: To Qualify: In order to be qualified, you must meet the following requirements: Education and Experience (Minimum Qualifications) Licensure as a Registered Nurse and two years of professional experience providing case management services in a social or health related field; OR one year of experience as a Health Care Coordinator II - Nurse in Nevada State service; OR licensure and an equivalent combination of education and experience. Special! Requirements A pre-employment criminal history check and fingerprintin! g are required.
A State of Nevada/FBI background check will be required of the selected applicant. A valid driver's license is required at the time of appointment and as a condition of continuing employment. Additional Position Experience Professional licensure as a registered nurse in the State of Nevada is required at the time of appointment and as a condition of continuing employment.
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If you were eligible to this vacancy, please give us your resume, with salary requirements and a resume to Nevada Employee Action and Timekeeping System.
Interested on this vacancy, just click on the Apply button, you will be redirected to the official website
This vacancy will be started on: Fri, 17 May 2013 09:32:46 GMT
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