Nurse Specialist
**This position may be located at any OIG location in the State in a hybrid work environment.
The Nurse III/Nurse Specialist performs advanced clinical review and consultative work for the Surveillance Utilization Review (SUR) division within the Office of Inspector General. Work performed in this position includes nursing work in reconsideration and corrective action processes for Medicaid Nursing Facilities (NFs). The Nurse Specialist uses advanced program knowledge and nursing expertise to evaluate medical records and perform reconsideration reviews when the original review has resulted in a change to the NF’s Minimum Data Set (MDS) assessment and ensures state rules, regulations, and written policies and procedures are applied. This position assists with the planning, development, and implementation of policies, procedures, and training materials; provides SUR staff with ongoing education; establishes and maintains effective working relationships and communication with HHS staff and other agencies and organizations; appropriately interacts with NFs and provides timely responses to requests and inquiries. The Nurse Specialist coordinates special projects as needed; and performs other duties as assigned to maintain efficient agency operations. This position works under minimal supervision of the director of SUR with extensive latitude and use of initiative and independent judgment. The Nurse Specialist is required to travel 15% of the time with potential of some overnight stays.
Essential Job Functions:
(50%) Uses technical and analytical skills review and evaluation of medical records submitted by NFs for reconsideration.
(25%) Uses advanced nursing knowledge to ensure that reconsideration and corrective action processes for NFs are consistently applied according to rules, regulations, and written policies and procedures. Promptly identifies inconsistencies and makes recommendations to management for action.
(15%) Assists with the planning, developing, and implementing of policies, procedures, and training materials and provides NFs and SUR staff with ongoing education.
(5%) Establishes and maintains effective working relationships and communication with HHS staff and other agencies and organizations; appropriately interacts with NFs and provides timely responses to requests and inquiries.
(5%) Performs other duties as assigned and keeps manager informed as necessary.
Knowledge Skills Abilities:
Knowledge of federal and state laws governing Medicaid policies and procedures and long-term care facilities.
Knowledge of resident assessment instrument, MDS items and form completion.
Knowledge of medical diagnoses, procedures and accepted medical treatment patterns.
Knowledge of or ability to apply methods of analysis, detection, and measurement of fraud, waste, and abuse.
Skill in communicating effectively, verbally and in writing.
Skill in establishing and maintaining effective working relationships.
Ability to apply nursing knowledge, practices, and procedures to components of job and in consultation; particularly the ability to interpret medical documents, including charts, narratives, plans of treatment and diagnosis.
Ability to interpret and apply policies, procedures and regulations.
Ability to develop and/or revise policies and procedures.
Ability to use personal computers and related software.
Ability to work under limited supervision.
Ability to plan, prioritize and coordinate work in an independent manner.
Ability to work well under pressure with limited time restraints.
Ability to travel 15% of time, with potential of some overnight stays required.
Registration or Licensure Requirements:
Licensed to practice as a Registered Nurse in the State of Texas or in a state recognized under the Compact Licensure Agreement.
License is current and in good standing.
Initial Selection Criteria:
Graduation from an accredited school of professional nursing, college, or university is required.
Full time experience in nursing facility administration and/or utilization review is highly desirable.
Advanced experience using a personal computer and software such as Word and Excel.
Prefer knowledge of MDS.
Additional Information:
**This position may be located at any OIG location in the State in a hybrid work environment.
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.
OIG will request that all applicants considered for an interview provide responses to in-basket questions. Failure to respond to the request could disqualify an applicant from the interview process.
Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
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.
MOS Code:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to: 68C, 66N/P/W, 290X, 46FX, 46NX, 46SX. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
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.
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