Nurse III Managed Care Nurse Analyst

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

Explore more details on the Benefits of Working at HHS webpage.

Functional

Title:

Nurse III Managed Care Nurse Analyst

Job Title:

Nurse III

Agency:
Health & Human Services Comm

Department: UR Acute Care FTE 75

Posting Number: 12658

Closing Date: 02/08/2026

Posting Audience:
Internal and External

Occupational Category:
Healthcare Practitioners and Technical

Salary Group: TEXAS-B-24

Salary Range: $5,425.33 - $8,886.16

Pay Frequency:
Monthly

Shift: Day

Additional

Shift: Days (First)

Telework:
Eligible for Telework

Travel:
Up to 25%

Regular/Temporary:
Regular

Full Time/Part Time:
Full time

FLSA Exempt/Non-Exempt:
Exempt

Facility

Location:

Job Location City: AUSTIN

Job Location Address: 701 W 51ST 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

Job Description:

The Nurse III, Managed Care Nurse Analyst, is a senior-level position that reports to an Acute Care Utilization Review Unit's (ACUR) Managed Care Clinical Review Manager.

If you are looking for an opportunity to use both considerable clinical experience and highly developed research and critical thinking skills, this job may be perfect for you.

This position is ideal for a registered nurse who wants to work with a team of highly advanced professionals to ensure Texas Medicaid recipients have appropriate access and coordination of medically necessary services through contracted managed care organizations (MCOs) in the STAR, STAR+PLUS, STAR Kids, and STAR Health programs.

This position performs complex assessments and analyses of Medicaid MCO utilization management policies and procedures, as well as clinical case files, to determine compliance with Texas Medicaid contracts and state and federal regulations.

The Managed Care Nurse Analyst must demonstrate an ability to work as an effective team member within ACUR and with other divisions within HHSC, be proactive in seeking input from other staff in the Medicaid/CHIP Division, and work with varying types of medical professionals.

Activities include desk reviews of utilization management documents, analysis of contract compliance, various forms of communication with MCO staff and leadership through email, conference calls, webinars, and onsite reviews at multiple MCOs across the state.

MCO onsite reviews include overnight travel and case discussion with MCO leadership.

Essential Job Functions (EJFs):

All essential job functions ensure compliance and knowledge of Texas Medicaid MCOs' utilization management with HHSC contracts and state and federal regulations related to STAR Kids, STAR, STAR+PLUS, and STAR Health programs:

* Reviews clinical documentation, Medicaid MCO policies and procedures, and authorization criteria. 25%

* Participates effectively in discussions of case, policy, and procedure reviews with MCO leadership and staff. Conducts interviews with utilization management staff members during onsite reviews. 15%

* Provides effective post-review follow-up by actively compiling findings and monitoring MCO activities related to non-compliance. 15%

* Demonstrates competency in internal processes and usage of ACUR clinical and utilization management review tools to ensure accurate and consistent findings 15%

* Provides clinical review of complaints and inquiries by analysis of clinical documentation. Prepares a written report of findings. 10%

* Accurately interprets complex state and federal laws, regulations, and rules related to Texas Medicaid Managed Care during review activities. 10%

* Provides consultation as a utilization management subject matter expert for the various activities to include contract procurement activities throughout the lifecycle of Texas Medicaid managed…