[Hiring] California Children's Services Case Management Nurse @California Correctional Health Care Services

Role Description

The Care Coordination Section is seeking a Nurse Evaluator (NE) II to perform the most difficult and sensitive work within the section to ensure evaluations and service requests are adjudicated timely. The NE II performs clinical evaluations, determines medical eligibility, and adjudicates service authorization requests for the California Children's Services (CCS) Program, the Medical Therapy Program and other statewide programs, as needed. The incumbent must:

• Apply program standards to specialty care, therapies, Durable Medical Equipment (DME) and other CCS covered benefits.
• Establish and maintain a working knowledge of the division's programs and policies.
• Respond to stakeholder and public sensitivities.

This position may be subject to the Department's Conflict of Interest Code and filing a Statement of Economic Interests (Form 700) when assuming office, annually while in office, and upon leaving office.

The results from the Nurse Evaluator II examination (Exam Code: 1924) will be utilized for filling this/these position(s).

This position is not eligible for a visa sponsorship. Applicants must be authorized to work in the US without the need for a visa sponsorship by the start date of employment.

Qualifications

• CA Registered Nurse License.

Requirements

• Experience applying problem-solving, critical thinking and/or analytical skills.
• Experience in interpreting medical documentation and applying Integrated Systems of Care Division (ISCD) program clinical criteria in order to determine eligibility and medical necessity.
• Experience in understanding pediatric specialty care.
• Experience researching and understanding policy, regulations, and laws.
• Experience in providing customer service and/or technical guidance.
• Ability to work in a fast-paced environment and adapt to evolving technical and operational requirements.

Benefits

• Continuous and ongoing training.
• Diversity, Equity, and Inclusion program activities.
• Employee Assistance Program (EAP).
• Medical, including health, dental, and vision insurance.
• Paid Holidays and vacation/leave.
• Defined retirement program.
• Savings Plus Program (401(k), 457).
• Medical/Dependent Care Reimbursement Accounts.

Company Description

DHCS' purpose is to provide equitable access to quality health care leading to a healthy California for all. DHCS is a dynamic organization with ambitious goals and talented, committed employees. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians. DHCS is committed to addressing disparities within our organization and in our communities through efforts toward greater diversity, equity, and inclusion.