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Equal Opportunity to all regardless of race, color, creed, national origin, ancestry, sex, marital status, disability, religious or political affiliation, age, or sexual orientation. It is the objective of the State of California to achieve a drug-free state workplace. Any applicant for State employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing civil service, and the special trust placed in public servants. |
Vacancy Search (VPOS)
HEALTH CARE SERVICES, DEPARTMENT OF
Title: NURSE EVALUATOR II, HEALTH SERVICES |
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Job Description: SROA CANDIDATES ARE ENCOURAGED TO APPLY. IF YOU ARE AN SROA APPLICANT, PLEASE ATTACH A COPY OF YOUR SROA LETTER TO YOUR APPLICATION. ELIGIBILITY REQUIREMENTS: State Employees - Individuals who are currently in this classification, eligible for lateral transfer or promotion, reachable on a certification list, or have SROA/Surplus status. Non-State Employees - To be considered for this vacancy, you must establish eligibility. Your first step in securing a job with the state will be to establish list eligibility by competing successfully in an appropriate exam. Often, exams are not offered at the same time as job opportunities. The Department of Health Care Services (DHCS) posts exams on the DHCS website at http://www.dhcs.ca.gov/services/admin/jobs/Pages/default.aspx and on the State Personnel Board’s website at http://www.spb.ca.gov/jobs/exams/exam_bulletins.htm. This position requires the incumbent 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 skill 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. Travel is required. Incumbent must be able to travel to provider sites and be flexible to travel on very short notice. Some overnight travel may be necessary to complete medical evaluations or attend meetings and other activities as directed by management. At all times, the incumbent must maintain an unrestricted valid registered nursing license with the California Board of Registered Nursing, Department of Consumer Affairs. Job Summary: The Nurse Evaluator II (NE II) functions as a member of a medical review team, which conducts reviews of Medi-Cal providers to include, but not be limited to physicians, clinics, laboratories, capitated health maintenance organizations, and other provider types. The NE II applies medical knowledge to perform evaluations of services and facilities; detect and develop cases where fraud and/or abuse is suspected; monitor and evaluate provider claiming patterns to assess if medical services rendered were medically necessary and billed appropriately; recommend appropriate actions based on the facts obtained; and, prepares reports for management review and approval. Duties will entail interviews with Medi-Cal recipients and families to verify the delivery of medical services and medical necessity.
For a complete duty statement, contact Wendy Cabrera at 909-605-2013; or, by e-mail at wendy.cabrera@dhcs.ca.gov.
Special Requirements: Travel is required |
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