Nurse II

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• Functional Title: Nurse II Job Title: Nurse II Agency: Health & Human Services Comm Department: UR Wav & Comm Srvs Ran Mmt St Posting Number: 17283

Closing Date

11/25/2026 Posting Audience: Internal and External Occupational Category: Healthcare Practitioners and Technical

Salary Range

$4,801.16 - $7,761.50 Pay Frequency: MonthlySalary Group: TEXAS-B-22 Shift: Day Additional Shift: Telework: Eligible for Telework Travel: Up to 75% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Exempt Facility Location: Job Location City: ARLINGTON Job Location Address: 2561 MATLOCK RD Other Locations: Abilene; Arlington; Bedford; Dallas; Decatur; Fort Worth; Grand Prairie; Irving; Mckinney; Plano; Rockwall; Weatherford MOS Codes: 290X,46AX,46FX,46NX,46PX,46SX,46YX,66B,66C,66E,66F,66G,66H,66N,66P,66R,66S,66T,66W The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualifiedcandidate to fill the position of Nurse II. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This positionmakes a significant contribution to MCS’s mission by ensuring individuals served in our 1915(c) waiver programs and CommunityAttendant Services (CAS) receive the appropriate type and amount of service.The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professionalstandards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity todo things right even when what is right is not easy.Under the direct supervision of the Utilization Review Nurse Manager, the utilization review (UR) nurse: reviews and evaluatesindividual's records, individual service plans (ISPs), patient assessments, documentation related to Title XIX and Title XX, and stateplan Medicaid community services for aged and disabled persons and individuals with intellectual and developmental disabilities (IDD);and conducts face to face interviews with individuals enrolled in the Community Attendant Services (CAS), Community LivingAssistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS),and Texas Home Living (TxHmL) programs to determine service justification. Based on the in-person, teleconference or telephoneinterview assessment, desk review and evaluation of services, the UR nurse uses program knowledge and nursing expertise todetermine appropriateness and quality of services, cost effectiveness of the service plan, validates determinations of health serviceneeds, and makes service authorization decisions.The UR nurse conducts a variety of quality assurance reviews, and quality improvement studies. The UR nurse evaluates assignedLevel of Need (LON) determinations in the IDD waiver programs when assigned to do so. This position works collaboratively with otherUR nurses and regional staff to implement an effective statewide UR program and to ensure UR policies and procedures are appliedconsistently. This position works under the general supervision of the UR Nurse Manager, with moderate latitude for use of initiative andindependent judgment. Essential Job Functions:Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.Conducts desk reviews of required documentation for Health and Human Services Commission (HHSC), Medicaid Long Term CareWaiver Programs and Community Attendant Services (CAS). Participates in onsite, televideo, or telephonic interviews of the individualsidentified in the random sample. Reviews, evaluates, and documents services provided to aged and disabled persons and persons withintellectual disability to validate service needs, service provision, determines appropriateness, quality, and cost effectiveness ofservices. (35%)Makes service authorization decisions on difficult, complicated, and/or targeted cases. (20%)Conducts a variety of quality assurance reviews and quality improvement studies and evaluates compliance with Medicaid programservice requirements, state rules, regulations, policies, and procedures. (10%)Works collaboratively with other UR nurses through routine and ad hoc meetings to implement an effective statewide UR program andto ensure UR policies and procedures are applied consistently. (10%)Develops, provides resources and technical assistance to regional staff and providers. (10%)Testifies as the Subject Matter Expert (SME) in Medicaid fair hearings related to appealed service reductions or denials. (5%)Produces routine and specialized data and information for program reports. (5%)Works collaboratively across MCS to identify innovative and effective solutions for clients and staff (5%) Registrations, Licensure Requirements or Certifications:Must be licensed as a professional Registered Nurse (RN) in the state of Texas or a state that recognizes reciprocity through the NurseLicensure Compact.Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a)required.Must have a valid Texas Driver License. Knowledge Skills Abilities:Meets the criteria for designation as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations483.430(a) required.Knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health andnursing care principles, quality management, utilization management, health care needs and services for elderly and disabled.Thorough knowledge of ID and other developmental disability related conditions, HCS, TxHmL, CLASS, DBMD, CAS, and ICF/IDprogram rules, service array and billing guidelines, local authority functions and waiver service system.Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports.Awareness of federal and state laws relating to long term care and other Medicaid and non-Medicaid services and programs.Knowledge of program planning, implementation and evaluation, and continuous quality improvement.Ability to communicate effectively, both orally and in writing.Ability to interpret statistical information.Ability to multi-task, handle stress and meet deadlines.Ability to work collaboratively across MCS to accomplish objectives.A keen attention to detail and the ability to implement creative solutions to problems.Able to balance team and individual responsibilities.Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports.Ability to: explain and interpret applicable health laws, rules, standards, and regulations; recognize patterns of medical necessitytreatment, fraud, abuse, and neglect; use a personal computer, copier, Microsoft Office suite and Outlook e-mail; travel throughout the state as necessary. Initial Screening Criteria:Two-year experience working as a Registered Nurse (RN).Graduation from an accredited four-year college or university with major course work in nursing preferred, or from an accreditednursing program. BSN preferred, experience and education may be substituted for one another.Must meet the federal definition of a Qualified Intellectual and Developmental Disability Professional as defined in 42 Code of FederalRegulations 483.430(a). Must have at least one year of experience working directly with persons with intellectual disability or otherdevelopmental disabilities.Must be able to travel 75% of the time.Experience in utilization review, or quality assurance activities in long term services and supports for the aged and disabled preferred. Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC. Active Duty, Military, Reservists, Guardsmen, and Veterans: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions. ADA Accommodations: In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview. Pre-Employment Checks and Work Eligibility: Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks. HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form Telework Disclaimer: This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.