Nurse III, Waiver Eligibility

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, Waiver Eligibility

Job Title:

Nurse III

Agency:
Health & Human Services Comm

Department:
Medical Directors Off 75-25

Posting Number: 19320

Closing Date: 08/27/2026

Posting Audience:
Internal and External

Occupational Category:
Healthcare Practitioners and Technical

Salary Range: $5,425.33 - $7,000.00

Pay Frequency:
Monthly

Salary 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

Job Description:

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.

Skills in:

* Organizing work.

* The care and treatment of patients, including the use of diagnostic and treatment tools and equipment.

*…