TX-HHSC-DSHS-DFPS·Austin, Texas
The Nurse III conducts complex clinical reviews of assessments and documentation to determine eligibility for Medicaid waiver programs. The role involves consulting with internal and external stakeholders to ensure medically necessary and cost-effective service delivery.
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Functional Title: Nurse III, Waiver Eligibility Job Title: Nurse III Agency: Health & Human Services Comm Department: Medical Directors Off 75-25 Posting Number: 19320
08/27/2026 Posting Audience: Internal and External Occupational Category: Healthcare Practitioners and Technical
$5,425.33 - $7,000.00 Pay Frequency: MonthlySalary Group: TEXAS-B-24 Shift: Day Additional Shift: Days (First) Telework: Travel: Up to 5% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Exempt Facility Location: Job Location City: AUSTIN Job Location Address: 4601 W GUADALUPE ST Other Locations: Austin MOS Codes: 290X,46AX,46FX,46NX,46PX,46SX,46YX,66B,66C,66E,66F,66G,66H,66N,66P,66R,66S,66T,66W Brief
The Nurse III, Waiver Eligibility, conducts reviews of assessments and other relevant documentation to make determination of eligibility for Medicaid waiver programs. The position also reviews additional information sent from the Medicaid Managed Care Organization (MCO), the member’s physician, or other sources to supplement information in the assessment completed by the MCO. Medicaid and CHIP Services (MCS) is driven by its mission to deliver quality, cost-effective services to Texans. The Office of the Medical Director (OMD) provides clinical consultation and guidance to other areas within MCS, throughout the Agency, and to external stakeholder organizations. It works to provide a clinical vision for improving the health of Texans by aligning MCS programs with state public health priorities. OMD also leads the utilization review team of MCS which is charged with ensuring that individuals receive medically necessary, cost-effective services. This position reports to the Medical Director for Waiver Eligibility. The work involved is highly complex (senior-level) clinical and consultative work. Work includes conducting reviews of assessments and other relevant documentation to make determination of eligibility for nursing facility waivers. The role includes reviewing additional information sent from the MCO, the member’s physician, or other sources to supplement information in the assessment completed by the MCO. Requires integrating knowledge of the Medicaid/CHIP programs with up-to-date healthcare practices and evidence-based clinical guidelines. Additionally, the Waiver Eligibility Nurse III consults with HHSC staff within MCS and across other HHSC departments as well as the Texas Department of State Health Services (DSHS). This position works under limited supervision with considerable latitude for the use of initiative and independent judgement. The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy. Essential Job Functions (EJFs): 1. Performs review of assessments and associated documentation for determination of waiver eligibility. Interprets complex state and federal laws, regulations, and rules related to the program. Responsible for timely and accurate reporting of results. (60%) 2. Represents unit at fair hearings and administrative reviews as needed. Reviews documentation generated internally and submitted from external sources as part of the proceedings. (25%) 3. Partners with internal and external clients to increase effectiveness of programs. Recommend areas to improve as result of review process. (10%) 4. Attends work on a regular and predictable schedule in accordance with agency leave policy. Performs other duties as assigned. (5%) Registrations, Licensure Requirements or Certifications: Requires a current license to practice as a Registered Nurse (RN) in the State of Texas (or a state that recognizes reciprocity through the Nurse Licensure Compact). Knowledge, Skills and Abilities (KSAs): Knowledge of:
Nursing principles, techniques, and procedures.
Health care laws, rules, standards, and regulations.
Medical diagnoses and procedures, accepted medical treatments, and nursing care principles, practices, and procedures.
Medicaid and managed care regulations and procedures.
Health care needs and services for pediatric and adult clients with special needs.
Organizing work. The care and treatment of patients, including the use of diagnostic and treatment tools and equipment. Written and verbal communication necessary to provide clear and concise determinations and reports. Establishing and maintaining productive working relationships both internally and externally.
Identify appropriate nursing care and other health care services.
Prepare, maintain, and present reports.
Explain and interpret applicable health laws, rules, standards, and regulations.
Understand and effectively interpret agency and program rules, policies, and procedures.
Use a personal computer, fax machine and copier, telephone conferencing functions, and components of the Microsoft Office Suite and Outlook email.
Gather, assemble, correlate, and analyze facts.
Devise solutions to problems.
Develop and evaluate policies and procedures.
Perform policy and medical literature research.
Communicate effectively orally and in writing.
Interact effectively and professionally with people from diverse cultural, socioeconomic, educational, racial, ethnic, and professional backgrounds.
Required: At least three years work experience as an RN in a health agency, hospital, or healthcare facility.
At least one year of clinical nursing experience with pediatric populations.
Bachelor of Science in Nursing or Master of Science in Nursing.
At least one year experience with utilization review and/or utilization management as demonstrated by job functions of current or previous positions.
At least one year experience with with long-term services and supports as demonstrated by job functions of current or previous positions.
At least one year experience with with adult and geriatric populations as demonstrated by job functions of current or previous positions.
N/AReview 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.
Candidates must hold a current Registered Nurse (RN) license in Texas or a compact state and possess at least three years of clinical nursing experience. A minimum of one year of pediatric nursing experience is required, with preference given to those with utilization review or long-term services experience.
Market context
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