Nurse III

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Job Description:

The Nurse III 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 reviewer 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 reviewer 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. 

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.  

Registrations, Licensure Requirements or Certifications:

Licensed to practice as a Registered Nurse in the State of Texas or in a state recognized under the Compact Licensure Agreement.

Applicant must be Resident Assessment Coordinator - Certified (RAC-CT) or be willing to obtain certification within three (3) months of start date.

License is current and in good standing.  

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.  

Initial Screening Criteria:

Graduation from an accredited school of professional nursing, college, or university is required.
Full time experience in nursing facility administration or utilization review required.
Experience using personal computers and Microsoft applications such as Microsoft Word and Microsoft Excel required.
Prefer knowledge of MDS

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS 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.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.