COMPLIANCE SPECIALIST - RN

Announcement Number: 45147 Open to all qualified persons. Posted 11/16/2023 Recruiter:
VICTORIA SHEEHAN
Phone: (775)684-0133
Email: torisheehan@admin.nv.gov Applications accepted until recruitment needs are satisfied

** Qualified individuals are encouraged to apply immediately. Lists of eligible candidates will be established and hiring may occur early in the recruiting process. Recruitment will close without notice when a sufficient number of applications are received or a hiring decision has been made.
The Position

Under direction, the Compliance Specialist - Registered Nurse provides medical expertise for the Division of Industrial Relations, Workers' Compensation Section. Incumbents monitor compliance and detect violations of State laws and/or regulations by medical providers, insurance carriers, Third Party Administrators (TPAs), medical billing vendors, employers, and in Permanent Partial Disability (PPD) reports; supervise lower-level Compliance/Audit Investigators; and oversee the Medical Unit in their assigned regions.

This recruitment is for a Compliance Specialist, Registered Nurse (RN) within the Department of Business and Industry's Industrial Relations Division. This position provides medical expertise for the Workers' Compensation Section; monitors compliance, detecting violations of State law by medical providers, insurers, third-party administrators, medical billing vendors, and employers; maintains Treating and Rating Panels of Physicians and Chiropractors as well as posting of insurers' provider lists as directed by the Compliance Coordinator-RN; supervises subordinate Medical Unit staff in the office; verifies medical providers and that claim file records are complete and appropriately documented;

ensures authorized services correlate with services provided/billed through the review of medical records; conducts interviews with stakeholders; documents findings and deficiencies; makes determinations regrading program violations, including recommendations for administrative actions such as fines; gathers data and assists with revising the Medical Fee Schedule; provides advice and assistance in the preparation of medical documentation and testimony for hearings/appeals; ensures compliance with standards of health care; trains internal and external stakeholders; investigates and recommends a warning, suspension, or removal of a provider from provider panels; conducts audits; reviews and identifies errors on Permanent Partial Disability (PPD) reports and facilitates PPD Review Panel meetings; resolves medical billing disputes, writing formal determinations as needed; and performs related duties as assigned. The State of Nevada is an equal opportunity employer dedicated to building diverse, inclusive, and innovative work environments with employees who reflect our communities and enthusiastically serve them. All applicants are considered without regard to race, color, national origin, religion or belief, age, disability, sex, sexual orientation, gender identity or expression, pregnancy, domestic partnership, genetic information (GINA), or compensation and/or wages. *** THIS RECRUITMENT MAY CLOSE WITHOUT FURTHER NOTICE DEPENDING ON THE NUMBER OF APPLICATIONS RECEIVED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE***

To see full Class Specifications visit: http://hr.nv.gov/Resources/ClassSpecs/Class_Specifications-10_0/

To Qualify:

In order to be qualified, you must meet the following requirements:
Education and Experience (Minimum Qualifications) Current license to practice as a Registered Nurse and two years of professional nursing experience, one year of which included professional experience in workers' compensation, occupational health, or case management; OR an equivalent combination of education and experience. Special Notes Travel within the state may be required. A Bachelor's degree in nursing is equivalent to a diploma or Associate's degree in nursing and one year of experience. Special Requirements A valid driver's license is required at the time of appointment and as a condition of continuing employment. The Examination Application Evaluation Exam The exam will consist of an application evaluation. It is essential that applications include detailed information with time frames regarding education and experience. The most qualified applicants will be contacted by the hiring agency for interview. The hiring agency may require specific skills related testing as part of the interviewing process. INFORMATIONAL LINKS For more information about state employment, visit the following:
Division of Human Resource Management: http://hr.nv.gov
Public Employees Retirement System: http://www.nvpers.org
Public Employees Benefits Program: http://pebp.state.nv.us
More Benefits Information: http://nvjobs.nv.gov/Applicants/EB
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Email Direct Inquiries or Correspondence to: Division of Human Resource Management
Northern Nevada
515 East Musser Street,
First Floor
Carson City, Nevada 89701-4204

Gardnerville, Nevada United States View Map