NEOGOV · 11 hours ago
HEALTH CARE COORDINATOR 4
Las Vegas
Full-time
Onsite
Mid, Senior Level
$67K/yr - $100K/yr
3+ years expNEOGOV is a part of the State of Nevada, seeking a Health Care Coordinator IV to supervise subordinate Health Care Coordinators within the Nevada Health Authority. The role involves overseeing case management services, developing procedures, and ensuring compliance with Medicaid policies.
GovTechHuman ResourcesInformation TechnologySoftware
Responsibilities
Assess potential client needs for case management services using assessment tools to identify social service and/or medical needs; develop and implement plans of care for those determined to be eligible for services; counsel and refer clients to services and/or contract with providers for services; maintain contact with clients through home visits and telephone calls; monitor the quality and cost of services provided to clients; periodically update plans of care; submit payment authorization requests; and maintain case files
Participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of services and resident care; ensure reimbursement matches the cost of services provided; monitor nursing facility quality indicator reports; screen and assess Medicaid clients regarding discharge to community-based care; review medical records; document findings and deficiencies on appropriate forms; prepare reports of findings and participate in exit conferences; participate in independent professional reviews of providers to determine the quality of care, compliance with patient rights, and appropriateness of placement as assigned
Review health care providers and fiscal agents to ensure clients are receiving appropriate services and payment is correct for services received; ensure providers and fiscal agents are in compliance with division policies and procedures; ensure employee health, certification and training needs are appropriate and properly documented in personnel records; verify client records have appropriate documentation and that authorized services correlate with services provided; confirm termination of services were appropriately documented and mandated reporting requirements were met; provide technical assistance regarding policies and procedures; complete written documentation using appropriate format; identify areas needing improvement and review plans of correction
Process payment authorization requests from providers to ensure the requested service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests; review pertinent medical information and previous requests; evaluate medical necessity to justify payment by comparing the diagnosis and other medical information with the request; refer requests to a medical consultant for another medical opinion as necessary; render determinations in accordance with Medicaid policy and notify providers of decisions
Review records from the fiscal agent, providers, clients and computer generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by the fiscal agent; refer financial errors to the fiscal agent for adjustment of charges and refer potential cases of fraud and abuse for further investigation
Explain proper billing procedures to contract providers selected by the client; monitor the quality of care given by the provider to clients; and submit billings for services provided to the fiscal agent for payment
Perform related duties as assigned
Under general direction, incumbents supervise positions in the Health Care Coordinator and Health Care Coordinator – Nurse classes, other journey level professional and support personnel including hiring, evaluating performance, and administering disciplinary action. Incumbents plan and organize unit operations; develop procedures and guidelines; coordinate staff activities; evaluate the quality and quantity of work performed; prepare reports and recommendations to management; plan, arrange and/or provide training to staff members and providers; participate in community and public relations activities as assigned and assist with budgetary recommendations such as staffing, travel and program needs. Incumbents may be assigned to oversee a single program unit or a variety of programs, and they may be working supervisors who also perform the duties described above
Qualification
Required
Licensure as a Social Worker or professional licensure or certification in a medical specialty applicable to the assignment
Three years of experience providing case management services in a social or health related field
One year of experience which included the interpretation and application of Medicaid policies and procedures
Experience coordinating reviews and services
Experience training staff and reviewing complex cases
Licensure and an equivalent combination of education and experience
Benefits
Health Insurance: Medical, dental, life, and disability insurance programs for employees and their dependents/family are offered through the Public Employees’ Benefits Program (PEBP).
Vacation: Accrual of three weeks of annual leave each year.
Sick Leave: Accrual of three weeks of sick leave each year.
Holidays: 12 paid holidays per year.
Retirement: Participation in the Nevada Public Employees Retirement System (PERS). Employees do not contribute to Social Security but will contribute to PERS if their position is at 50% or more full-time equivalency.
Deferred Compensation: The State offers a voluntary Deferred Compensation Program.
No Nevada state income tax.
Public Service Loan Forgiveness: Eligible due to public sector employment.
Longevity Payments Eligibility: Employees who have received a performance rating of “standard” or better and have completed eight (8) or more years of continuous service are eligible for longevity pay.
Company
NEOGOV
NEOGOV is the leading provider of workforce management software uniquely designed for the public sector, education, and public safety.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$700MKey Investors
The Carlyle Group,Warburg PincusWarburg Pincus
2025-07-28Secondary Market· $700M
2025-07-28Acquired
2021-06-02Private Equity
Leadership Team
Shane Evangelist
CEO
Brandon McDonald
Head Of Marketing
Recent News
Canada NewsWire
2025-11-14
2025-11-14
Government Technology US
2025-10-31
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