Title: NURSE EVALUATOR IV, HEALTH SERVICES Salary: $5,379.00 - $6,976.00 Posted: 08/02/2013
Job Description: Interested applicants please indicate position # 805-041-8149-001 and basis of eligibility in box number 12 of the STD 678 (State Application Form). Failure to do say may result in the disqualification of your application. Please submit applications and inquiries to the contact person listed above.
This position requires the incumbent to maintain consistent and regular attendance; communicate effectively (orally and in writing) in dealing with the public and/or other employees; develop and maintain knowledge and skills related to specific tasks, methodologies, materials, tools, and equipment; complete assignments in a timely and efficient manner; and, adhere to departmental policies and procedures regarding attendance, leave, and conduct.
Job Summary: Under the general supervision of the Branch Chief, In-Home Operations (IHO), the Nurse Evaluator (NE) IV performs a wide variety of complex administrative, management, supervisory, and analytical tasks as supervisor of multidisciplinary staff in the IHO Southern Regional Office, located in Los Angeles.
The Southern Regional Office consists of multidisciplinary staff: three (3) Nurse Evaluator IIIs, multiple Nurse Evaluator IIs and three (3) clerical support staff who are responsible for the development, implementation, evaluation, monitoring and authorization of select home and community-based services under the Medi-Cal program. These services include the administration and authorization of related services for two federally funded Home and Community-Based Services (HCBS) waivers, the In-Home Operations and Nursing Facility/Acute Hospital (NF/AH) waivers.
The NE IV is responsible for ensuring that internal program policies and procedures are followed and that Medi-Cal administrative procedures are adhered to in accordance with state and federal statutes and regulations. The NE IV is also responsible for working collaboratively with intra- and inter-departmental staff on issues impacting program services.
The NE IV must demonstrate an in-depth knowledge of the complex, continuously evolving and interactive components of the home and HCBS programs under the LTCD. The NE IV will act as a liaison with, and as a consultative resource for intra-and inter-departmental staff on program policies and procedures.
The NE IV must have the ability to reason logically and creatively and utilize a variety of analytical techniques to resolve complex programmatic and managerial problems; develop and evaluate alternatives; analyze data and present ideas and information effectively both orally and in writing; consult with and advise staff and upper management on programmatic issues; establish and maintain program priorities, and effectively utilize available programmatic resources. The NE IV will be expected to assume duties which may vary according to specific topic in technical complexity.
The NE IV must possess knowledge of principles and practices of employee supervision, development and training; methods and techniques of effective leadership; Federal, State and local health programs, policies, objectives, and constraints; equal employment opportunity and affirmative action policies.
Supervision Received: General supervision the Chief of In-Home Operations Branch.
Supervision Exercised: The NE IV position is in the Southern Regional Office located in Los Angeles and the incumbent is responsible for managing the IHO Southern Regional Office, directly supervising three (3) Nurse Evaluator III Supervisors, and indirectly supervising multiple Nurse Evaluator (NE) IIs.
DESCRIPTION OF DUTIES
The nature and duties of this position necessitates travel, which occasionally may require overnight stays.
60%: The NE IV is responsible for the overall operation and administration of the IHO Southern Regional Office and staff. Plans, organizes, and directs the work of three (3) NE III Supervisors, and indirectly supervises multiple NE IIs, and three (3) clerical support staff. The NE IV is responsible for all related personnel matters and the promulgation of personnel reports related to these staff. The NE IV ensures that internal program policies and procedures are followed and that Medi-Cal and HCBS waiver administrative procedures are adhered to in accordance with state and federal statutes and regulations. Works collaboratively with intra- and inter-departmental staff on issues impacting program services. Establishes and maintains cooperative relationships with other departmental programs and local health care providers involved in regulating or providing health care services to waiver participants. Interfaces with waiver participants, providers, protection and advocacy groups, and other governmental agencies to educate and remove obstacles to the success of the program. Regularly reports and keeps the Branch Chief informed of critical issues.
25%: The NE IV is responsible for the Southern Region’s ongoing case management, evaluation and, coordination of HCBS services for active waiver participants, as well as managing Intake case development activities by ensuring a systematic transition of eligible Medi-Cal beneficiaries to HCBS waiver programs. The NE IV is responsible for the strategic planning and scheduling of onsite Intake evaluations and periodic case management visits by the NE IIs. The NE IV makes recommendations regarding a waiver applicant’s or participant’s level of care, home care and/or nursing needs, medical necessity for requested services and/or durable medical equipment, and the home and/or family situations to ensure a safe environment. The NE IV must ensure the continuity of the criteria, policies; procedures, rules, and statutes used for level of care determinations, TAR adjudication, and issuance of Notices of Action by staff are appropriately applied. The NE IV provides technical training on level of care, medical necessity, durable medical equipment, Medi-Cal policy, regulatory and waiver criteria to staff as needed. The NE IV responds to complex and/or sensitive inquiries from waiver providers and/or participants.
10%: The NE IV must work closely with numerous organizations including Children’s Medical Services, Regional Centers, the Department of Developmental Services, the Department of Social Services, public and private managed care programs, and Centers for Medicare and Medicaid Services (CMS). Interfaces with beneficiaries, providers, protection and advocacy groups, and other governmental agencies to educate, train, and remove obstacles to the success of the program. The NE IV handles sensitive contacts with the legislature, legal and advocacy groups, and controlled correspondence on issues related to HCBS waivers, and is highly involved in policy, legislative, and regulatory development and implementation.
5%: Perform other duties as required.
Nurse Evaluator IV
805 - 041 - 8149 - 001
Final Filing Date:
DHCS-UMD P.O. Box 997419, MS 4506 Sacramento, 95899-7419
Wilson Jew 916-552-9171
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