Nurse Evaluator IV

Nurse Evaluator IV

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, as well as through collaboration with the federal government and other state agencies, counties, and partners, in caring for low-income families, children, pregnant women, older adults, and individuals with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today!

About this Role:

The Nurse Evaluator IV (NE IV) is responsible for a wide variety of complex administrative, supervisory, and day-to-day management tasks for a multidisciplinary staff in the Clinical Assurance Division (CAD). The incumbent will be charged specifically with managing the utilization review process for services requested by Medi-Cal providers on a Treatment Authorization Request (TAR) form. TARs and supporting documentation are reviewed and adjudication based on broad medical criteria and professional judgment by a staff of Nurse Evaluators and Medical Consultants. The NE IV oversees the authorization of medically necessary services to Medi-Cal eligible fee-for-service beneficiaries using the least costly alternative to meet their medical needs. The incumbent will ensure that TAR decisions are consistent and that Medi-Cal policies and regulations are uniformly applied. This position requires a broad spectrum of clinical knowledge and experience as well as Medi-Cal program knowledge. Travels to attend meetings and/or conduct provider/staff training.

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. This recruitment is until filled and applications will be reviewed on a bi-weekly basis. The cutoff dates will be: September 17, 2026, September 30, 2026, October 15, 2026, October 30, 2026, November 12, 2026, November 26, 2026, December 17, 2026, December 31, 2026, January 14, 2027, January 28, 2027, February 11, 2027, and February 25, 2027.

SPECIAL NOTE: Temporary Authorization Appointment (TAU) appointments may be considered for this vacancy, and such appointments may become permanent provided the selected candidate obtains a reachable rank on the associated examination. Please see below "Who May Apply" section for more information.

You will find additional information about the job in the Duty Statement.