JOB This position is with the Department of Health and Human Services in the Division of Nevada Health Authority (NVHA) and is located at the Las Vegas District Office. This position requires less than fifty percent of time travelling within the Las Vegas District Office catchment area. Health Care Coordinators (HCC’s) evaluate individuals referred to the medical services program and provide ongoing case management services to Medicaid eligible clients; evaluate the need for medical services, treatment, equipment and supplies and authorize payment; screen individuals to determine appropriate level of care in nursing homes; review programs and participate in program development. This position will also assist walk-ins in the District Office lobbies to provide the member information regarding benefits and to troubleshoot complicated access to care issues.
Health Care Coordinators perform professional work related to program operations and auditing providers to ensure compliance with program policies and regulations. They evaluate individuals referred to the medical services program and provide ongoing case management services to Medicaid eligible clients; evaluate the need for medical services, treatment, equipment and supplies and authorize payment; screen individuals to determine appropriate level of care in nursing homes; review programs to ensure services are being provided in a cost effective manner; participate in program development by providing input on policies and procedures, forms, medical coverage and system enhancements. EXAMPLE OF DUTIES Licensure as a Social Worker or professional licensure or certification in a medical specialty applicable to the assignment, and one year of professional experience providing case management services in a social or health related field; OR one year of experience as a Health Care Coordinator I in Nevada State service; OR licensure and an equivalent combination of education and experience. SUPPLEMENTAL INFORMATION This job specification lists the major knowledge, skills and abilities of the job and is not all inclusive. Incumbent(s) will be expected to have knowledge, skills and abilities from a previous level.
Working knowledge of: theories, principles, practices and methods of social work, nursing, or a health care profession applicable to the program assignment; case management practices applicable to the program assignment; interviewing techniques; crisis intervention techniques; assessment tools used to evaluate clients; normal and abnormal human growth, behavior and development.
General knowledge of: federal regulations and State laws applicable to the program assignment; anatomy, physiology, pharmacology, and psychology; medical and pharmaceutical terminology; services, roles and responsibilities of social service agencies; impact of diseases and disabilities on individuals.
Ability to: manage a caseload of individuals with significant physiological, developmental, emotional and psychological problems and related disorders; determine initial and ongoing ability to meet the criteria for pertinent agency programs; read and interpret program regulations and policies; access and verify information using computer equipment and records; analyze health and social information to determine risk factors, client needs and functional level; monitor and evaluate services provided; research, review, and interpret medical records and make recommendations; develop and implement plans of care including authorizing services as appropriate; document case activities and write reports; provide instruction and direction to clients and others in group or individual settings.
Recruiter Contact Information: Victoria Sheehan - [email protected]
