California Children's Services (CCS) Case Management Nurse (Telework) (Nurse Evaluator II, Health Services)

Job Description and Duties Why Join DHCS? The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today! About this Role: 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. The incumbent must establish and maintain a working knowledge of the division’s programs and policies as well as be able to respond to stakeholder and public sensitivities. Please review the attached duty statement for further details about this position. 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). Have questions and/or need assistance? Contact recruit@dhcs.ca.gov, we are here to help walk you through the state hiring process! 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. You will find additional information about the job in the Duty Statement. Special Requirements • The position(s) require(s) a(n) CA Registered Nurse License. You will be required to provide a copy of your license prior to being hired. Simple Application Steps If you are interested in this position, complete the following simple steps: • Review the education and experience minimum qualifications (MQ’s) of the Nurse Evaluator II classification, Nurse Evaluator II Series MQs. See the Minimum Requirements section of this posting. • Submit your application package with all required documents, see the "Required Application Package Documents" section below. • Once you have applied, take the Nurse Evaluator II examination (Exam Code: 1924) examination. Education: If you are using education to meet the minimum qualifications, you must include a copy of your diploma/degree and/or unofficial/informal transcripts for verification. Official transcripts may be required upon appointment. Desirable Qualifications In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate: • 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 being able to adapt to evolving technical and operational requirements.