Utilization Review has the following position open for All Applicants:
Category:
Healthcare Practitioners and Technical
FLSA Exempt/Non-Exempt: Exempt
Agency: Health & Human Services Comm
Department: UR LTSS
Job Title: Nurse V
Posting Number: 369154
Full Time/Part Time: Full Time
Regular/Temporary: Regular
Job Location: 11501 BURNET ROAD
City: AUSTIN
Contact: AccessHR Service Center
Telephone: 888-894-4747
Salary Range: $5,258.66 – $8,624.25
Salary Group: B25
Shift: Days (First)
Travel: 40%
Closing Date: 01/31/2018
Job Description:
Under the general supervision of the Unit Manager for Managed Long Term Services and Supports Utilization Review, the Nurse V is responsible for highly advanced activities related to utilization review of long-term services and supports in Medicaid managed care, including STAR+PLUS, STAR Kids, and other managed care programs. This position acts as a lead nurse for the Utilization Review unit by supervising, overseeing and evaluating the activities of local Nurse IVs in the unit; making recommendations for improvement; providing consultation and quality assurance oversight over the reviews conducted by the Nurse IVs; developing protocols and determining compliance with policies, procedures, rules, laws, and standards, conduct of needs assessments, and justification for levels of Medicaid community services. The UR Nurse V is responsible for researching and selecting the most appropriate evaluation methods based on the type of review being conducted, including review of medical records, needs assessments, individual services plans, and other relevant documentation. This position may make home visits for nursing assessments and for validation of service needs and service delivery as part of the quality assurance and oversight function. This position has extensive latitude for use of initiative and independent nursing judgment in the oversight of the UR nursing activities for the unit; analyzes statistical data and evaluation reports; and makes recommendations for improvements. The UR Nurse V will work with the UR staff to oversee the development of UR strategies and tools to assess appropriateness of services through the managed care service delivery system. The UR Nurse V will assess utilization review outcomes as part of the internal quality assurance activity; and work with other HHSC staff, and managers to develop in service training, educational programs, and technical assistance for managed care organizations and provider agencies. The UR Nurse V oversees the development of statewide UR program planning activities, consults with the UR Manager on program priorities, and is responsible for project implementation in the assigned program areas.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Acts as a lead nurse by supervising, planning, and assigning work to other unit nurses, and providing leadership in the development, coordination, and evaluation of program activities.25% Oversees, guides and evaluates nursing staff in the development of program protocols, review procedures, and tools to ensure UR activities are in compliance with agency, state, and federal rules, laws, statutes, and guidelines. 25% Oversees and evaluates the quality assurance and improvement program and processes for the unit. 20% Oversees and evaluates program outcomes through the use of statistical studies and reports.15% Develops and evaluates training and technical assistance for staff, managed care organizations, provider agencies, and the medical community. 10% Performs visits to various applicable settings for clinical learning experiences. 5%
Knowledge Skills Abilities:
Knowledge of: managing staff; nurse techniques and procedures, health care laws, rules, standards and regulations; medical diagnoses and procedures; accepted medical treatment patterns and practices; community health and nursing care principles, practices and procedures; quality management; utilization management and review principles and practices; knowledge of the medical necessity and level of care determination for individuals in a home and community based waiver; knowledge of health care needs and services for individuals who are aged or disabled; and knowledge of Medicaid managed care. Skill in: written and verbal communication necessary to manage staff, develop and maintain unit policies, rules, and guidelines, to consult, teach, and provide clear and concise direction, and to clearly explain reports resulting from data analysis. Ability to: identify appropriate nursing and other health care services; prepare, maintain and present reports; explain and interpret applicable health laws, rules, standards, and regulations; recognize patterns of medical necessity fraud and abuse. Ability to: gather, assemble, correlate, and analyze facts; devise solutions to problems; develop and evaluate policies and procedures. Ability to use a personal computer, fax machine, copier, telephone conferencing functions, and components of Microsoft Office Suite and Outlook e-mail. Ability to travel independently throughout the state as necessary. Ability to plan, assign, and supervise the work of others.
Registration or Licensure Requirements:
Must possess a current, unencumbered Texas Registered Nurse license (or a state that recognizes reciprocity through the Nurse Licensure Compact). Obtain and maintain RUG certification
Initial Selection Criteria:
Current, unencumbered Texas Registered Nurse License (or a state that recognizes reciprocity through the Nurse Licensure Compact). Bachelor’s degree in nursing preferred, but other bachelor’s degrees or years of experience will be considered. Knowledge of Texas Medicaid, managed care organizations, long term services and supports regulations and procedures, and utilization review principles and practices.
Additional Information:
Note: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include: 68C, 66N/P/W, 290X, 46FX, 46NX, 46SX. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx. Req #369154
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In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.