Nurse Evaluator Ii, Health Services

Why Join DHCS? The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities.

This is an exciting opportunity to join our diverse team in the following role.

Under direction of the Nurse Evaluator III in the Department of Health Care Services' (DHCS) Clinical Assurance Division (CAD), the Nurse Evaluator II (NE II) performs professional nursing duties as part of the medical review team, including utilization review, post-claims oversight, and adjudication of Treatment Authorization Requests (TARs) to ensure services provided to Medi-Cal beneficiaries meet medical necessity and comply with Medi-Cal policy.

The NE II reviews patient histories and medical records, prepares draft reports and responses for fair hearings, and provides guidance to providers, beneficiaries, and other Department and government staff on medical policies and procedures. Travel statewide, including overnight, of up to 5% of the time, by airplane, train, automobile, and other transportation methods is required to perform job related tasks such as attend meetings and conduct provider outreach.

Travel related duties are dependent upon workload and operational need. New to state candidates will be hired into the minimum salary of the classification or minimum of the alternate salary range when applicable. Placement to alternate range may be based on education or experience identified in your state application.

In order to be considered for the vacancy, all candidates must be eligible for appointment. If you already have list eligibility for this classification, you do not need to retake the examination, except when your list eligibility expires. This position is designated under the Conflict of Interest Code. The position is responsible for making or participating in the making of governmental decisions that may potentially have a material effect on personal financial interests.

The appointee is required to complete Form 700 within 30 days of appointment and once per year. Failure to comply with the Conflict of Interest Code requirements may void the appointment.

Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply.

Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).

The Hiring Unit Contact is available to answer questions regarding the position or application process. Hiring Unit Contact:
Lani Su Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office. EEO Contact: EEO Officer

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