Health Care Coordinator - Nurse

State of Nevada•Las Vegas, NV

3d•Hybrid

About The Position

The Nevada Medicaid Division of the Nevada Health Authority is seeking a Health Care Coordinator - Nurse in Las Vegas. The position uses case management experience to support and oversee children receiving in-home care through the Katie Beckett Eligibility Option. This position oversees and supports case management for children with medically fragile conditions or intellectual disabilities who receive care at home, helping families navigate available Medicaid services. It includes assessing the level of care needed to safely maintain the home environment and guiding families on services provided through Nevada Medicaid. The role requires home visits to evaluate the child’s needs in the home, conducted at least annually, and involves some travel. This position may also participate in auditing skilled nursing facilities using the Minimum Data Set, with certification in this process potentially required within the first year. Health Care Coordinator - Nurses perform work related to program operations and auditing providers to ensure compliance with program regulations and policies.

Requirements

One or more years of applicable experience as described in the job duties
Licensure as a Registered Nurse issued by the Nevada State Board of Nursing.

Nice To Haves

Certification in auditing skilled nursing facilities using the Minimum Data Set potentially required within the first year.

Responsibilities

Assess potential client needs for case management services.
Develop, implement, and update plans of care.
Counsel and refer clients to services and/or contract with providers for services.
Monitor the quality and cost of services provided and submit payment authorization requests.
Establish and maintain case files.
Review facilities, provide care to validate, and ensure adequacy of services and resident care.
Review information, document findings and deficiencies, prepare reports, and participate in conferences.
Review health care providers and fiscal agents for compliance.
Ensure clients are receiving appropriate services and payment is correct for services received.
Identify areas needing improvement and review plans of correction.
Process payment requests to ensure medical necessity and compliance and approve or deny requests.
Review records from the applicable parties, identify abuse and potential fraud, and ensure proper payment.
Refer errors to the fiscal agent for adjustment and refer potential cases of fraud and abuse for investigation.
Explain billing procedures, monitor quality of care, and submit billings to the fiscal agent for payment.
Perform related duties as assigned.