Nurse II

Texas Health and Human Services - San Antonio, TX

Job Title: Nurse II

Position: Utilization Review Nurse

Job Type: Full Time

Pay: $4,801.16 - $7,761.50 Monthly

Shift: Day (First)

Work Type: On-Site

Location

Address:

City: San Antonio

State: TX

ZIP Code:

Job Responsibilities

Conduct desk reviews of required documentation for 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 individuals with intellectual disabilities to validate service needs 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
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
Develop and 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
Identify innovative and effective solutions for clients and staff

Required Skills

Core Skills

Knowledge of nursing healthcare laws, rules, standards, and regulations
Understanding of medical diagnoses and procedures
Strong written and verbal communication skills
Ability to multi-task and handle stress
Attention to detail
Ability to communicate effectively both orally and in writing
Knowledge of program planning, implementation, and evaluation

Preferred Skills

Experience in utilization review or quality assurance activities in long term services and supports
Familiarity with ID and other developmental disability-related conditions

Requirements

Experience: Two years working as a Registered Nurse (RN); at least one year of experience working directly with persons with intellectual disability or other developmental disabilities

Education: Graduation from an accredited four-year college or university with major course work in nursing preferred, or from an accredited nursing program

License & Certification:

Licensed as a professional Registered Nurse (RN) in Texas or a state that recognizes reciprocity through the Nurse Licensure Compact
Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 CFR 483.430(a)
Valid Texas Driver License

Schedule:

Ability to travel 75% of the time

COVID-19 Requirements: Not Specified

Benefits

100% paid employee health insurance for full-time eligible employees
Defined benefit pension plan
Generous time off benefits
Numerous opportunities for career advancement

Supplemental Pay

Not specified

Special Notes

Active-duty military, reservists, guardsmen, and veterans are encouraged to apply
ADA accommodations are available during the hiring and selection process