Medicaid Review Nurse - Central Office

State of Nebraska•Lincoln, NE

3d•Onsite

About The Position

The Nebraska Department of Correctional Services (NDCS) is seeking a Medicaid Review Nurse for its Central Office in Lincoln, NE. This role is crucial for managing and processing all Medicaid applications for incarcerated individuals within NDCS. The position involves coordinating Medicaid eligibility, enrollment, authorizations, covered services, and continuity of care. The nurse will assist with applications and renewals, support hospital and discharge planning, and resolve coverage issues. Utilizing nursing knowledge, the role identifies services eligible for Medicaid reimbursement, monitors utilization and expenditures, and contributes to cost-saving strategies. Additionally, the position performs quality control for internal and external medical services and must be adaptable to changing priorities and additional duties as needed.

Requirements

A current license to practice as a Licensed Practical Nurse in Nebraska or authority based on the Nurse Licensure Compact to practice as a Licensed Practical Nurse in Nebraska is required.
Must possess a valid driver's license.
Must be able to lift up to 50 lbs. with assistance.
Will complete four to eight weeks of on-the-job training.
Must submit to security background check.
Applicants accepting a job offer must pass the pre-employment medical examination and a drug test.
Must successfully complete the fully paid NDCS Pre-service Training Program.

Nice To Haves

Demonstrates proficiency in data entry, including accurate and timely entry of information into applicable systems, spreadsheets, and databases.
Strong keyboarding skills and the ability to maintain a high level of accuracy while processing information efficiently.
Prior experience working with Medicaid applications, eligibility determination, or Medicaid reimbursement processes.
Experience with utilization review, CQI processes, or peer review practices.
Experience using electronic health record, tracing systems, or medical claims databases.
Experience reviewing, processing, and tracking applications, medical records, or similar complex paperwork requiring attention to detail and accuracy.
Experience in correctional healthcare, public health, or working with justice-involved populations.

Responsibilities

Manages and processes all Medicaid applications for NDCS incarcerated individuals.
Coordinates Medicaid eligibility, enrollment, authorizations, covered services, and continuity of care.
Assists with applications and renewals.
Supports hospital and discharge planning.
Addresses coverage issues.
Uses nursing knowledge to identify services eligible for Medicaid reimbursement.
Monitors utilization and expenditures.
Supports cost-saving strategies.
Performs quality control duties for internal and external medical services.
Adapts to changing priorities and assists with additional duties as needed.

Benefits

Starting wage $40.000/hour.
Additional $3.00/hour facility differential for hours worked.
13 paid holidays
Vacation and sick leave (24 days your first year, accruing immediately)
Military leave
156% state-matched retirement
Tuition reimbursement
Employee assistance program
79% employer paid health insurance plans
Dental and vision insurance plans
Employer-paid $20,000 life insurance policy
Public Service Loan Forgiveness Program (PSLF) eligible through the Federal government
Meaningful public service -- service with a purpose!
Numerous training and development opportunities