Nurse III Policy Analyst

TX-HHSC-DSHS-DFPS • Austin, TX

6d • Hybrid

About The Position

The Nurse Policy Analyst (Nurse III) position reports to a Medical and Dental Benefits Policy Manager in the Office of Policy, Medicaid and CHIP Services Department. The Nurse Policy Analyst performs complex medical benefits policy analysis, development, and consultation. The Nurse Policy Analyst in this position will serve as the subject matter expert for a variety of medical topics, with a focus primarily on hearing device and audiology services.

This position requires excellent writing skills and strong research skills, including experience conducting comprehensive literature reviews using PubMed/Medline, Hayes, and other health literature electronic databases; must be able to synthesize findings for clinical and non-clinical audiences, and apply findings to medical benefits for policy development in the Medicaid program. These findings must be interpreted correctly in accordance with the Texas Medicaid program's requirements for application and development of Medicaid’s medical benefits.

The Nurse Policy Analyst in this position will be asked to participate in internal and external stakeholder workgroups, must be proactive in seeking input from other staff in the Medicaid/CHIP Division, and demonstrate the ability to work as an effective team member with peers, other divisions within HHSC, and other HHS agencies.

Requirements

• Must have a current license to practice as a Registered Nurse in Texas or a state that recognizes reciprocity through the Nurse Licensure Compact.
• Knowledge of Health and Human Services agencies and programs, including Medicaid/CHIP
• Knowledge of Computer use, including but not limited to the use of Microsoft Office suite
• Knowledge of General clinical coding resources such as Current Procedural Terminology (CPT) and International Classification of Diseases (ICD)
• Knowledge of Quality assurance principals.
• Skill in Evaluating the quality and levels of evidence presented in the literature
• Skill in Synthesizing findings for clinical and non-clinical audiences
• Skill in Clinical practice guideline evaluation or development; clinical quality assessment, assurance, or improvement; clinical research or health care delivery
• Skill in Written, verbal, and interpersonal communication and presentation skills
• Skill in Project planning, evaluation, and implementation
• Skill in Establishing and maintaining effective working relationships with managers, co-workers, and other staff or program stakeholders.
• Ability to Work independently and function effectively as a member of a team, and under tight deadlines with high volume workloads
• Ability to Conduct comprehensive literature reviews using electronic databases such as PubMed/Medline, Hayes, or other similar electronic sources such as UpToDate, and reviewing professional organization’s recommendations for best practices
• Ability to Manage several projects concurrently in a fast-paced environment and juggle competing priorities. Detail and task oriented
• Ability to Effectively facilitate meetings and establish and advance agenda goals
• Ability to Stay organized
• Bachelor’s degree from an accredited 4-year college or university.
• Master’s degree in public health, health policy, biology, or other social/behavioral health field or 4 years' experience in an area that provided equivalent experience.
• Experience analyzing clinical research and applying findings to work
• Experience or familiarity with literature reviews of medical research topics.

Nice To Haves

• Clinical coding certificate preferred.
• Bachelor’s of Nursing degree preferred
• Master’s degree in nursing preferred

Responsibilities

• Clinical Review of the Literature- Researches, analyzes, evaluates, and synthesizes peer-reviewed literature and evidence-based practices for application to Medicaid medical, dental, and mental health benefit policy. Synthesizes complex technical medical information verbally or in writing for clinical and nonclinical audiences. Consults with stakeholders to address Medicaid program benefit policy issues.
• Develops policies- Reviews and updates current benefits and develops new benefits for Medicaid medical policy. Identifies eligibility standards and authorization requirements for benefit policy. Collaborates, as needed, with staff in Medical Benefits, HHSC, other State agencies, and the claims system administrators for program benefit policy development, planning, and implementation. Serves as clinical subject matter expert in the development and review of program benefit policy. Develops, reviews, and provides comments on Medicaid materials intended for use by vendors, providers, managed care organizations, and other partners.
• Quality Assurance - Participates in quality assurance activities through the development and review of program medical, dental, and mental health benefits, including: reviewing documentation, reviewing and approving medical benefits language for internal and forward-facing publications, documenting and tracking research, reviewing policy development, discussions, and draft program benefit policy changes. Researches provider or manufacturer questions or concerns. Maintains organized electronic files of activities and shares with staff and partners, as appropriate. Assists in the review and referral of complaints concerning medical and other providers and services.
• Special Projects and Workgroups - Leads or participates in workgroups and public meetings engaged in research, analysis, and evaluation of policy issues or initiatives. Leads or participates in special projects as requested by management. Positively represents department, agency, and State in conferences and meetings, including public presentation delivery, and as an ongoing representative on various committees and teams, as directed. Prepares project updates, summaries, reports, or other documents and keeps management informed on pertinent issues. Functions as a resource to other State staff providing guidance, advice, or direction. Responds to internal and external communications and requests for information in a timely manner. Identifies the need to and communicates and consults with external stakeholders, as necessary.
• Regulation review - Reviews, analyzes, and comments on regulations affecting program benefit policy. Other duties, as assigned, include but are not limited to actively participating in or serving in a supporting role to meet the agency's obligations.

Benefits

• comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
• defined benefit pension plan
• generous time off benefits
• numerous opportunities for career advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees