Nurse Evaluator Ii, Health Services - San Diego County, CA, United States - Department of Health Care Services
Description
Why Join DHCS?
About this Role:
The role of the Nurse Evaluator II is to support the Contract and Enrollment Review Division for DHCS.
CERD conducts state mandated medical and compliance reviews and audits to verify compliance with contractual requirements. Provider types audited include medical, dental and behavioral health managed care plans; Drug Medi-Cal Organized Delivery Systems.
Other work performed include federally mandated post-service, post-payment behavioral health utilization reviews; provider enrollment onsite reviews of high and moderate risk prospective Medi-Cal providers; onsite reviews for site certification and recertification of county-owned or operated Specialty Mental Health providers; and other requested third-party contract compliance reviews.
Our focus is to improve the effectiveness and efficiency of DHCS and the programs it administers.To assure the proper and efficient operation of the Medi-Cal Program, the Nurse Evaluator II (NE II) uses professional nursing knowledge, expertise and judgment to perform program integrity functions which include onsite reviews of Medi-Cal providers, evaluation of medical documentation of services, and provision of expert medical testimony at administrative appeals hearings in collaboration with management and legal counsel.
Travel may be required up to 20% of the time, including overnight stays.You will find additional information about the job in the
Duty Statement.
Working Conditions
- Please see the Telework Information section below for telework details.
- Minimum Requirements
- NURSE EVALUATOR II, HEALTH SERVICES
- Job Application Package Checklist
- Duty Statement
Job Code #:
- JC427213
Position #(s):
-
Working Title:
Nurse Evaluator II (Hybrid Option)
Classification:
- NURSE EVALUATOR II, HEALTH SERVICES
-
# of Positions:
- Multiple
Work Location:
- San Diego County
Telework:
- Hybrid
Job Type:
- Permanent, Full Time
- Department Information
- DHCS is California's health care safety net, helping millions of lowincome and disabled Californians each and every day. DHCS' purpose is to provide equitable access to quality health care leading to a healthy California for all.
- DHCS is a dynamic organization with ambitious goals and talented, committed employees. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians. DHCS is committed to addressing disparities within our organization and in our communities through efforts toward greater diversity, equity, and inclusion. This is accomplished, in part, by a commitment toward employing a diverse workforce that reflects the many communities we serve, and by promoting and enforcing equal employment opportunity.
- Take a look at some of DHCS' recent projects and happenings that our department has accomplished in the DHCS Newsroom
Simple Application Steps
If you are interested in this position, complete the following these simple steps:
Review the education and experience minimum qualifications (MQ's) of the Nurse Evaluator II classification. See the Minimum Requirements section above.
- Once you have applied, take the Nurse Evaluator II Examination.
At all times it is required that the incumbent maintain a valid and active registered nursing license with the California Board of Registered Nursing.
Education:
If you are meeting minimum qualifications with education, you must include a copy of your diploma/degree and/or unofficial/informal transcripts for verification.
Official transcripts may be required upon appointment.- Application Instructions
-
Who May Apply
Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process.
Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).-
How To Apply
-
Address for Mailing Application Packages
Department of Health Care Services
- Attn: Certification Technician
- M.
- P.
- Sacramento, CA
Address for Drop-Off Application Packages
Department of Health Care Services
-1501 Capitol Avenue, Suite
- Sacramento, CA
-08:00 AM - 05:00 PM
Required Application Package Documents
- Resume is optional. It may be included, but is not required.
Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview.
Desirable Qualifications
- This position requires the incumbent maintain
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