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SalaryWork for Indiana
Grow your career with the State of Indiana! With more than 50 executive branch agencies, the State of Indiana is a diverse workforce offering employees stimulating and challenging projects across a broad scope of career opportunities. As a State of Indiana employee, you impact the well-being of Indiana’s communities every day.
At the State of Indiana, we don’t just talk about diversity and inclusion - Our goal is to create a welcoming, accessible, and equitable workplace, with a workforce that is representative of the State of Indiana population. As a proud equal opportunity employer, reasonable accommodations may be available to enable individuals with disabilities to complete the application and interview process, as well as perform the essential functions of a role.
Next Level benefits at the State of Indiana are here! Be sure to review our expanded benefit package offerings below.
About the Indiana Department of Health (IDOH):
The Indiana Department of Health’s mission is to promote, protect, and improve the health and safety of all Hoosiers so that they can reach their optimal health regardless of where they live, learn, work, or play.
Salary Statement:
The salary for this position traditionally starts at $47,320.00 but may be commensurate with education or work experience.
Role Overview:
You will determine medical eligibility for special needs children that are making application for the CSHCS program. You will evaluate and ensure that all medical records or requests for authorization of payment and specialty care linkages are in compliance with CSHCS rules and policies are directly related to the eligible medical condition(s). You will need to recognize and update possible medical diagnoses needs for program participants . You will explain program in detail to program participants and families regarding requirements, e.g., Indiana resident, notification of changes in address, income, insurance coverage, service coverage or termination and eligibility-related criteria to providers. You will apply problem-solving skills by recommending medical solutions or giving needed referrals to appropriate agencies and assist participants in transistion from CSHCS program due to age or non-eligibility to another program, agency or to any available services. You will need to complete timely re-determination of medical eligibility for the CSHCS. You will attend appeal hearings as needed when a participant is denied an authorization of a service or medical eligibility.
Purpose of Position/Summary
The incumbent serves as a Nurse Consultant, determines medical eligibility of applicants and provides prior authorization of services to families of participants with serious, chronic medical conditions to obtain medical treatment related to the participant's medical condition. The incumbent provides consultation to local agencies and interprets Children's Special Health Care Services (CSHCS) program policies to participants, families, providers and the public.
Short Description
Essential Duties and Responsibilities:
1. Determine medical eligibility for special needs children that are making application for the CSHCS program.
2. Evaluates and ensures that all medical records or requests for authorization of payment and specialty care linkages are in compliance with CSHCS rules and policies are directly related to the eligible medical condition(s).
3. Recognizes and updates possible medical diagnoses needs for program participants.
4. Explains program in detail to program participants and families regarding requirements, e.g., Indiana resident, notification of changes in address, income, insurance coverage, service coverage or termination and eligibility-related criteria to providers.
5. Applies problem-solving skills by recommending medical solutions or giving needed referrals to appropriate agencies.
6. Assist participants in transition from CSHCS program due to age or non-eligibility to another program, agency or to any available services.
7. Completes timely re-determination of medical eligibility for the CSHCS.
8. Attends appeal hearings as needed when a participant is denied an authorization of a service or medical eligibility.
9. Performs other duties as required.
Long Description
Job Requirements
1. Commitment to the public health mission of protecting the health, safety, rights and privacy of program
participants and their families.
2. Specialized knowledge of nursing principles, techniques and medical needs as applied to the population served, primarily children with chronic medical conditions.
3. Considerable knowledge of and the ability to review and analyze medical records and documents.
4. Considerable knowledge of program rules and policies.
5. Specialized knowledge of rehabilitation including therapy and durable medical equipment.
6. Working knowledge of insurance and Medicaid.
7. Ability to communicate verbally and in writing with individuals and in group situations.
8. Ability to be flexible and maintain composure under stressful situations.
9. Ability to manage time and complete assignments without constant supervision.
10.Understanding of and ability to work as a member of a team.
11.Working knowledge of computers.
What You'll Need for Success:
You must meet the following requirements to be considered for employment:
Registered Nurse license (active within state of Indiana).
Strongly prefer at least one (1) year of pediatric RN experience.
Specialized knowledge of the Indiana Medicaid Program including federal and state laws.
Specialized knowledge of nursing principles.
Specialized knowledge of medical services provided through Medicaid.
Must be committed to the public health mission of protecting the health, safety, rights, and privacy of program participants and their families.
Working knowledge of medical diagnoses with their symptoms.
Working knowledge of drugs, side effects and compatibility.
Working knowledge of therapeutic and rehabilitative services.
Ability to recognize realistic limitations of services provided.
Ability to be flexible and to prioritize in complex situations.
Effectively utilize professional communication skills.
Ability to master computer-based data systems.
Ability to maintain cooperative work relationships.
Difficulty of Work
Incumbent utilizes established rules, policies and directives on a daily basis. Incumbent uses nursing judgment in interpreting guidelines to participants, families, providers and the public. Incumbent seeks medical information by researching files, medical books and journals and the internet.
Personal Work Relationships:
Working Conditions:
Benefits of Employment with the State of Indiana:
The State of Indiana offers a comprehensive benefit package for full-time employees which includes:
Three (3) medical plan options (including RX coverage) as well as vision and dental plans
Wellness Rewards Program: Complete wellness activities to earn gift card rewards
Health savings account, which includes bi-weekly state contribution
Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities
Deferred compensation 457B account (similar to 401k plan) with employer match
Two (2) fully-funded pension plan options
A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:
150 hours of paid new parent leave
Up to 15 hours of paid community service leave
Combined 180 hours of paid vacation, personal, and sick leave time off
12 paid holidays, 14 on election years
Education Reimbursement Program
Group life insurance
Referral Bonus program
Employee assistance program that allows for covered behavioral health visits
Qualified employer for the Public Service Loan Forgiveness Program
Free Parking for most positions
Free LinkedIn Learning access
Equal Employment Opportunity:
The State of Indiana is an Equal Opportunity Employer and is committed to recruit, select, develop, and promote employees based on individual ability and job performance. Our policy is to provide equal employment opportunity to all people in all aspects of employer-employee relations without discrimination because of race, color, creed, religion, sex, national origin, ancestry, age, sexual orientation, gender identity, physical or mental disability, or veteran status. We will comply with the spirit as well as the letter of all applicable state and federal laws.
If you are a qualified individual with a disability and require reasonable accommodation in completing this application, you can request assistance by contacting the Indiana State Personnel Department at jobs@spd.IN.gov.
The State of Indiana has established a culture that welcomes equity, inclusion, and opportunity for all employees and applicants. We encourage you to apply if you feel you have the transferrable skills to be successful in this position and we look forward to reviewing your application.
