Texas Health and Human Services Commission
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 Clinical Reviewer Job Title:
Nurse II Agency:
Health & Human Services Comm Department:
UR Wav & Comm Srvs Ran Mmt St Posting Number:
9499 Closing Date:
10/07/2025 Posting Audience:
Internal and External Occupational Category:
Community and Social Services Salary Group:
TEXAS-B-22 Salary Range:
$4,801.16 - $6,281.33 Pay Frequency:
Monthly Shift:
Day Additional Shift:
Days (First) Telework:
Eligible for 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:
701 W 51ST ST Other Locations: 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 Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Nurse II. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS's mission by providing oversight and monitoring of provider requirements with Individual Plans of Care (IPC), enhanced staffing rate requests for Individualized Skills and Socialization services, and Level of Care/Level of Need (LOC/LON) determinations.
The Nurse II position provides highly complex consultative and technical assistance, including research and assessment directly to management, HHSC program staff, local authority (LIDDA) staff, the Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Intermediate Care Facility (ICF/ID) provider base, advocacy groups, stakeholders, program participants and their families.
The utilization review (UR) nurse reviews and evaluates program records, medical records, needs assessments, individual plans of care (IPCs), and other documentation related to proposed service plans for individuals enrolled in the Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Intermediate Care Facility (ICF/ID) programs based on documentation received from program service planning teams. Based on these reviews and evaluation, the UR nurse uses program knowledge and clinical expertise to determine the appropriateness, quality, and cost effectiveness of each request and to assess and validate determinations of health needs and service provision for the purpose of making service authorization and levels of need decisions.
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.
Responsibility for this position includes the following: Routinely reviews and analyzes forms turned in for enhanced rates for Individualized Skills and Socialization services including reviewing documents to determine why an enhanced rate is needed and authorizing the rate for a short term or ongoing need. Analyzes Intellectual Disability/Related Condition (ID/RC) data to assess the need for additional oversight. Conducts desk reviews to determine compliance with HHSC rules, policies and procedures related to enrollments, IPCs and LOC/LONs. Conducts utilization review and evaluation of proposed IPCs and makes clinical authorization decisions regarding participant eligibility and plans of care. Evaluates IPC and eligibility activities and trends to resolve technical problems, identify opportunities for improvement and to make recommendations for improvements in utilization review processes. Conducts analysis of data and reports as assigned, and collects, organizes, analyzes and prepares materials in response to requests for program information, or special project reports. Develops and revises utilization review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals. May serve as the lead to prioritize the work of colleagues by assigning provider deliverables to designated unit staff in absence of the unit supervisor. Serves as agency representative in Medicaid fair hearings. Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures. Coordinates the review and evaluation of information on service delivery system methods, outputs, and activities in order to identify gaps in resources and recommend improvements. Coordinates and collaborates with program staff through participation in unit and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Routinely reviews and analyzes forms turned in for enhanced rates for Individualized Skills and Socialization services including reviewing documents to determine why an enhanced rate is needed and authorizing the rate for a short term or ongoing need. (10%)
Provides highly complex consultative and technical assistance, including research, assessment and planning directly to management, HHSC program staff, HHSC contract management staff, local authority (LA) staff, the program provider base, advocacy groups, stakeholders, program participants and their families. (20%)
Oversees and monitors provider requirements with Individual Plans of Care (IPC) and Level of Care/Level of Need (LOC/LON) determinations. (30%)
Conducts analysis of data and reports as assigned, and collects, organizes, analyzes and prepares materials in response to requests for program information, or special project reports. (10%)
Serves as agency representative in Medicaid fair hearings. (5%)
Develops and revises utilization review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals. (5%)
Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures. (5%)
Coordinates and collaborates with program staff through participation in unit, agency and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives. (5%)
Will serve as the lead to prioritize the work of colleagues by assigning provider deliverables to designated unit staff during the absence of the supervisor. (5%)
Works collaboratively across MCS to identify innovative and effective solutions for clients and staff. (5%)
Registrations, Licensure Requirements or Certifications:
Must be a Registered Nurse with a valid RN license.
Knowledge, Skills, and Abilities:
Knowledge of:
IDD and other developmental disability related conditions, HCS, TxHmL, CLASS, DBMD and ICF/ID program rules, service array and billing guidelines, local authority functions and waiver service system.
Skill of:
Must be a Registered Nurse with a valid RN license.
Ability:
To communicate effectively, both orally and in writing.
Initial Screening Criteria:
Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required.
At least one year of experience working with individuals with intellectual/developmental disabilities or related conditions preferred.
Prior experience working in Texas waiver service system is preferred.
Additional Information:
N/A
Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.
Active Duty, Military, Reservists, Guardsmen, and Veterans :
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor's Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.
ADA Accommodations:
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Pre-Employment Checks and Work Eligibility:
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.
HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form
Telework Disclaimer:
This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.
Functional Title:
Nurse Clinical Reviewer Job Title:
Nurse II Agency:
Health & Human Services Comm Department:
UR Wav & Comm Srvs Ran Mmt St Posting Number:
9499 Closing Date:
10/07/2025 Posting Audience:
Internal and External Occupational Category:
Community and Social Services Salary Group:
TEXAS-B-22 Salary Range:
$4,801.16 - $6,281.33 Pay Frequency:
Monthly Shift:
Day Additional Shift:
Days (First) Telework:
Eligible for 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:
701 W 51ST ST Other Locations: 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 Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Nurse II. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS's mission by providing oversight and monitoring of provider requirements with Individual Plans of Care (IPC), enhanced staffing rate requests for Individualized Skills and Socialization services, and Level of Care/Level of Need (LOC/LON) determinations.
The Nurse II position provides highly complex consultative and technical assistance, including research and assessment directly to management, HHSC program staff, local authority (LIDDA) staff, the Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Intermediate Care Facility (ICF/ID) provider base, advocacy groups, stakeholders, program participants and their families.
The utilization review (UR) nurse reviews and evaluates program records, medical records, needs assessments, individual plans of care (IPCs), and other documentation related to proposed service plans for individuals enrolled in the Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Intermediate Care Facility (ICF/ID) programs based on documentation received from program service planning teams. Based on these reviews and evaluation, the UR nurse uses program knowledge and clinical expertise to determine the appropriateness, quality, and cost effectiveness of each request and to assess and validate determinations of health needs and service provision for the purpose of making service authorization and levels of need decisions.
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.
Responsibility for this position includes the following: Routinely reviews and analyzes forms turned in for enhanced rates for Individualized Skills and Socialization services including reviewing documents to determine why an enhanced rate is needed and authorizing the rate for a short term or ongoing need. Analyzes Intellectual Disability/Related Condition (ID/RC) data to assess the need for additional oversight. Conducts desk reviews to determine compliance with HHSC rules, policies and procedures related to enrollments, IPCs and LOC/LONs. Conducts utilization review and evaluation of proposed IPCs and makes clinical authorization decisions regarding participant eligibility and plans of care. Evaluates IPC and eligibility activities and trends to resolve technical problems, identify opportunities for improvement and to make recommendations for improvements in utilization review processes. Conducts analysis of data and reports as assigned, and collects, organizes, analyzes and prepares materials in response to requests for program information, or special project reports. Develops and revises utilization review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals. May serve as the lead to prioritize the work of colleagues by assigning provider deliverables to designated unit staff in absence of the unit supervisor. Serves as agency representative in Medicaid fair hearings. Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures. Coordinates the review and evaluation of information on service delivery system methods, outputs, and activities in order to identify gaps in resources and recommend improvements. Coordinates and collaborates with program staff through participation in unit and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Routinely reviews and analyzes forms turned in for enhanced rates for Individualized Skills and Socialization services including reviewing documents to determine why an enhanced rate is needed and authorizing the rate for a short term or ongoing need. (10%)
Provides highly complex consultative and technical assistance, including research, assessment and planning directly to management, HHSC program staff, HHSC contract management staff, local authority (LA) staff, the program provider base, advocacy groups, stakeholders, program participants and their families. (20%)
Oversees and monitors provider requirements with Individual Plans of Care (IPC) and Level of Care/Level of Need (LOC/LON) determinations. (30%)
Conducts analysis of data and reports as assigned, and collects, organizes, analyzes and prepares materials in response to requests for program information, or special project reports. (10%)
Serves as agency representative in Medicaid fair hearings. (5%)
Develops and revises utilization review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals. (5%)
Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures. (5%)
Coordinates and collaborates with program staff through participation in unit, agency and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives. (5%)
Will serve as the lead to prioritize the work of colleagues by assigning provider deliverables to designated unit staff during the absence of the supervisor. (5%)
Works collaboratively across MCS to identify innovative and effective solutions for clients and staff. (5%)
Registrations, Licensure Requirements or Certifications:
Must be a Registered Nurse with a valid RN license.
Knowledge, Skills, and Abilities:
Knowledge of:
IDD and other developmental disability related conditions, HCS, TxHmL, CLASS, DBMD and ICF/ID program rules, service array and billing guidelines, local authority functions and waiver service system.
Skill of:
Must be a Registered Nurse with a valid RN license.
Ability:
To communicate effectively, both orally and in writing.
Initial Screening Criteria:
Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required.
At least one year of experience working with individuals with intellectual/developmental disabilities or related conditions preferred.
Prior experience working in Texas waiver service system is preferred.
Additional Information:
N/A
Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.
Active Duty, Military, Reservists, Guardsmen, and Veterans :
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor's Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.
ADA Accommodations:
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Pre-Employment Checks and Work Eligibility:
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.
HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form
Telework Disclaimer:
This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.