Nurse 3

BMS2700005 Position Number: 0511P05772 Job Location: Kanawha County Under general supervision, this resource will perform the following duties and functions: Perform pre-payment and post-payment reviews of Medicaid services, from a medical standpoint on a wide variety of providers to determine accuracy of claims submitted, documentation requirements being met, medical necessity criteria and adherence to Medicaid policy. Serve as lead person to identify medical necessity for the service and/or procedure, areas of concern and course of action needed. Provide written reports to the program administrator of the Medicaid program assessed regarding compliance with program policy. Communicate with medical practitioners/ facilities verbally and in writing on Medicaid program policy coverage and procedure coding matters. Development of Medicaid program and procedures in coordination with program staff. Review and update procedure editing criteria. Independently evaluate medical services and specialized Plans of care. Coordinates with other medical Professionals in evaluating appropriate treatment of Medicaid recipients. Perform professional medical review of treatment practice and patient utilization patterns are reflected in profiles generated by the Medicaid claims processing system, serve on the selection team in determining what providers to review. Provide recommendations regarding program deficiencies and educational needs. Identify, develop, implement and utilize technical criteria for reviewing, and evaluating medical necessities. This position will also perform other duties needed to support the office and Bureau as assigned.

Position Number: 0511P05772

PG: 16 $43,357 - $75,789 Market Rate: $67,395 Special Hiring Rates: $64,171.95 - West Virginia Veterans Nursing Facility in Clarksburg, WV (SPB 2961) $45,032.00 - Jefferson County Health Department (SPB 2973) Appointment Incentive: $5,347.50 at WV Veterans Nursing Facility in Clarksburg, WV $5,781.00 at DHHR non-facilities Email applications to: [email protected] Mail to: Shantrace B. Elsea, at 350 Capitol Street, Room 251, Charleston, WV 25301. Please include posting number BMS2700005 on application. Please note: Applications of covered state employees, mailed to DOP or completed via DOP's on-line method are not forwarded.

PG: 16 $43,357 - $75,789

Market Rate: $67,395

Special Hiring Rates:

$64,171.95 - West Virginia Veterans Nursing Facility in Clarksburg, WV (SPB 2961)

$45,032.00 - Jefferson County Health Department (SPB 2973)

$5,347.50 at WV Veterans Nursing Facility in Clarksburg, WV

$5,781.00 at DHHR non-facilities