[Hiring] Nurse IV Policy Analyst @Texas Health & Human Services Commission

Role Description

The Healthy Texas Women (HTW) Nurse Policy Analyst - Nurse IV position reports to one of the Medical and Dental Benefits Policy Managers in the Medicaid and CHIP Services division of the Health and Human Services Commission. The position performs highly advanced and/or supervisory (senior-level) medical benefit policy analysis for the Healthy Texas Women (HTW) benefit program. Work involves planning, developing, coordinating, and evaluating HTW medical benefit policy updates.

The 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 political audiences and apply findings to medical benefits for policy development in the HTW program. These findings must be interpreted correctly in accordance with the HTW's program requirements for application to and development of HTW medical benefits.

The Nurse Policy Analyst in this position must be proactive in seeking input from other staff in the Medicaid and CHIP Services Division and demonstrate the ability to work independently, and as an effective team member with peers, other divisions within HHSC, and other HHS agencies. This position works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.

Essential Job Functions

• Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
• Keeps the Medical Benefits Manager informed of pertinent HTW program medical benefit issues and coding impacts as required or as necessary. (30%)
• Clinical Review of the Literature - Researches, analyzes, and synthesizes peer-reviewed literature and evidence-based practices and applies it to program medical and behavioral health benefit policy. Provides complex technical medical information verbally or in writing to nonclinical audiences. Consults with stakeholders to address HTW program benefit policy issues. (30%)
• Develops policies - Reviews and updates current benefits and develops new benefits for HTW medical policy. Identifies eligibility standards and authorization requirements for benefit policy. Collaborates, as needed, with Medical Benefits staff as well as HHSC staff in other programs and other State agencies 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 HTW materials intended for use by vendors, providers, managed care organizations, and other partners. (25%)
• 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. (15%)
• Quality Assurance and Process Improvement - Identifies methods for effectively managing benefit changes that have varying effective dates. Researches provider or manufacturer questions or concerns. Maintains organized electronic files of activities and shares with staff and partners, as appropriate. 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.

Qualifications

• Bachelor’s degree from an accredited 4-year college or university. Bachelor’s of Nursing degree preferred.
• 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. Master’s degree in nursing preferred.
• Experience analyzing clinical research and applying findings to work.
• Experience or familiarity with literature reviews of medical research topics.

Requirements

• Knowledge of Health and Human Services agencies and programs, including Medicaid/CHIP and the HTW program.
• Computer use, including but not limited to the use of Microsoft Office suite.
• General clinical coding resources such as Current Procedural Terminology (CPT) and International Classification of Diseases (ICD).
• Quality assurance principles.
• Skill in evaluating the quality and levels of evidence presented in the literature.
• Synthesizing findings for clinical and non-clinical audiences.
• Clinical practice guideline evaluation or development; clinical quality assessment, assurance, or improvement; clinical research or health care delivery.
• Written, verbal, and interpersonal communication and presentations.
• Project planning, evaluation, and implementation.
• 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.
• 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.
• Manage several projects concurrently in a fast-paced environment and juggle competing priorities.
• Effectively facilitate meetings and establish and advance agenda goals.
• Consistently remain organized and detail- and task-oriented.

Benefits

• 100% paid employee health insurance for full-time eligible employees.
• A defined benefit pension plan.
• Generous time off benefits.
• Numerous opportunities for career advancement.