HEALTH CARE COORDINATOR 4
State of Nevada (NV), Nevada, IA, United States
Job Overview
The Aging and Disability Services Division (ADSD) is currently recruiting for a Health Care Coordinator 4 in Reno, Nevada. This recruitment may be used to fill current and future vacancies as they occur in the following program: Home and Community Based Services (HCBS). This is a supervisory position that will manage a team consisting of case managers and administrative assistants.
Responsibilities
Oversee a team of case managers and administrative assistants to ensure case management and administrative tasks are completed within required timeframes, and program services are established and monitored for program recipients.
Provide coaching, discipline and performance management, and develop productive relationships and open communication with support staff, supervisor staff and sister agencies.
Assume staff duties and tasks during extended absences, vacancies and unforeseen circumstances.
Interpret and apply program procedures, policies and methods to train and educate staff.
Review, respond to and complete reports and program inquiries within required timeframes and communicate program issues to upper management.
Attend mandatory training, classes as required.
Review facilities providing care to Medicaid‑eligible clients to validate adequacy of services and resident care, ensuring reimbursement matches costs and maintaining quality indicator reports.
Screen and assess Medicaid clients for discharge to community‑based care, review medical records, document findings, prepare reports, and participate in exit conferences.
Review health care providers and fiscal agents to ensure clients receive appropriate services and payment is correct, verify compliance with division policies, verify documentation and reporting requirements, provide technical assistance, and complete written documentation.
Process payment authorization requests, evaluate medical necessity, refer to medical consultants as needed, render determinations per Medicaid policy and notify providers.
Identify abuse and potential fraud from fiscal agent and provider records, refer financial errors for adjustment, and refer potential cases for further investigation.
Explain billing procedures to contract providers, monitor quality of care, and submit billings for payment.
Perform related duties as assigned.
Supervise Health Care Coordinator positions, hiring, evaluating performance, administering disciplinary action, plan and organize unit operations, develop procedures, coordinate staff activities, review quality and quantity of work, prepare reports and recommendations, plan training, participate in community relations, and assist with budgetary recommendations.
Qualifications
Licensure as a Social Worker or professional licensure or certification in a medical specialty applicable to the assignment, and three years of experience providing case management services in a social or health related field, with at least one year of experience interpreting Medicaid policies, coordinating reviews and services, training staff and reviewing complex cases; or licensure and an equivalent combination of education and experience.
Assess client needs for case management services using assessment tools; develop and implement plans of care; counsel and refer clients; maintain contacts through visits and calls; monitor quality and cost; update plans; submit payment authorization requests; maintain case files.
Knowledge, Skills, and Abilities
Detailed knowledge of:
federal regulations, State laws and agency directives applicable to the program assignment; mission, goals and objectives of the division; agency policies and procedures.
Working knowledge of:
system interface between all division programs.
General knowledge of:
basic principles of training and supervision, data collection techniques, principles of budgeting.
Ability to:
prepare and present verbal and written reports; recruit and train staff; delegate and assign work to subordinates; evaluate employee performance and provide constructive feedback; mediate and negotiate between parties; establish program and staff goals and objectives; determine appropriate training and equipment needs; facilitate staff meetings.
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The Aging and Disability Services Division (ADSD) is currently recruiting for a Health Care Coordinator 4 in Reno, Nevada. This recruitment may be used to fill current and future vacancies as they occur in the following program: Home and Community Based Services (HCBS). This is a supervisory position that will manage a team consisting of case managers and administrative assistants.
Responsibilities
Oversee a team of case managers and administrative assistants to ensure case management and administrative tasks are completed within required timeframes, and program services are established and monitored for program recipients.
Provide coaching, discipline and performance management, and develop productive relationships and open communication with support staff, supervisor staff and sister agencies.
Assume staff duties and tasks during extended absences, vacancies and unforeseen circumstances.
Interpret and apply program procedures, policies and methods to train and educate staff.
Review, respond to and complete reports and program inquiries within required timeframes and communicate program issues to upper management.
Attend mandatory training, classes as required.
Review facilities providing care to Medicaid‑eligible clients to validate adequacy of services and resident care, ensuring reimbursement matches costs and maintaining quality indicator reports.
Screen and assess Medicaid clients for discharge to community‑based care, review medical records, document findings, prepare reports, and participate in exit conferences.
Review health care providers and fiscal agents to ensure clients receive appropriate services and payment is correct, verify compliance with division policies, verify documentation and reporting requirements, provide technical assistance, and complete written documentation.
Process payment authorization requests, evaluate medical necessity, refer to medical consultants as needed, render determinations per Medicaid policy and notify providers.
Identify abuse and potential fraud from fiscal agent and provider records, refer financial errors for adjustment, and refer potential cases for further investigation.
Explain billing procedures to contract providers, monitor quality of care, and submit billings for payment.
Perform related duties as assigned.
Supervise Health Care Coordinator positions, hiring, evaluating performance, administering disciplinary action, plan and organize unit operations, develop procedures, coordinate staff activities, review quality and quantity of work, prepare reports and recommendations, plan training, participate in community relations, and assist with budgetary recommendations.
Qualifications
Licensure as a Social Worker or professional licensure or certification in a medical specialty applicable to the assignment, and three years of experience providing case management services in a social or health related field, with at least one year of experience interpreting Medicaid policies, coordinating reviews and services, training staff and reviewing complex cases; or licensure and an equivalent combination of education and experience.
Assess client needs for case management services using assessment tools; develop and implement plans of care; counsel and refer clients; maintain contacts through visits and calls; monitor quality and cost; update plans; submit payment authorization requests; maintain case files.
Knowledge, Skills, and Abilities
Detailed knowledge of:
federal regulations, State laws and agency directives applicable to the program assignment; mission, goals and objectives of the division; agency policies and procedures.
Working knowledge of:
system interface between all division programs.
General knowledge of:
basic principles of training and supervision, data collection techniques, principles of budgeting.
Ability to:
prepare and present verbal and written reports; recruit and train staff; delegate and assign work to subordinates; evaluate employee performance and provide constructive feedback; mediate and negotiate between parties; establish program and staff goals and objectives; determine appropriate training and equipment needs; facilitate staff meetings.
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