Nurse Evaluator II

Job Description and Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is a dynamic organization with ambitious goals and talented, committed team members. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to millions of Californians. This is an exciting opportunity to work in the Investigations Division, Audits and Investigations. Our mission is to protect and enhance the integrity of the health programs administered by DHCS. We are seeking an individual to join our diverse team in the Nurse Evaluator II civil service classification. If you are interested in joining our team, apply today!

Please see the Special Requirements section for simple and easy steps on how to apply for this state position.

About this Role:

To assure the proper and efficient operation of the Medi-Cal Program, the Nurse Evaluator II within the Data Analytics & Case Development Branch , uses professional nursing knowledge, expertise and judgment to perform program integrity functions which include onsite reviews of Medi-Cal providers, evaluation of medical documentation of services and drugs, and provision of expert medical testimony at administrative appeal and criminal hearings in collaboration with management and legal counsel. The incumbent must have the ability to act independently, be flexible, open-minded, and tactful in dealing with team members, audit leads, managers, and executive management. The incumbent must be able to accurately convey medical program integrity findings effectively, both orally and in written form. Travel of up to 10% is required, including statewide overnight travel may be necessary to complete audits, attend training, meetings and other activities as directed by management. Incumbent must be able to travel to provider sites and be flexible to travel on short notice.

Have questions and/or need assistance? Contact  View email address on calcareers.ca.gov , we are here to help walk you through the state hiring process!

This position is subject to the Department’s Conflict of Interest Code and filing a Statement of Economic Interests (Form 700) when assuming this position, annually by April 1, and when leaving this position.

You will find additional information about the job in the .

Working Conditions

Please see the Telework and Salary Information section below for telework, reporting location, and temporary statewide salary reduction details.

Special Requirements

Simple Application Steps

If you are interested in this position, complete the following these simple steps:

1. Review the education and experience minimum qualifications (MQ’s) of the  classification. See the Minimum Requirements section above.
2. Complete an application package and statement of qualifications, if applicable, for this position.
3. Submit your application package with all required documents - see Required Application Package Documents section below. .
4. Once you have applied, take the  .

At all times it is required that the incumbent maintain a valid and active registered nursing license with the California Board of Registered Nursing.

Education: If you are meeting minimum qualifications with education, you must include a copy of your diploma/degree and/or unofficial/informal transcripts for verification. Official transcripts may be required upon appointment.

DHCS will review your application package and contact you after the job posting/final filing date.

*** The position requires a Live Scan prior to being hired***

Successful candidates are required to submit to a background investigation process, including mandatory electronic fingerprinting via the California Department of Justice (DOJ) Live Scan system.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

This position requires the incumbent maintain consistent and regular attendance; communicate effectively, orally and in writing, in dealingwith the public and/or other employees; develop and maintain knowledge and skill related to specific tasks, methodologies, materials, toolsand equipment; complete assignments in a timely and efficient manner; and, adhere to departmental policies and procedures regarding attendance, leave, and conduct.

Desirable Skills include:

Strong clinical expertise; Experience in identifying fraud, waste or abuse experience, regulatory and policy knowledge, good communication skills (both written and verbal); Strong ability to analyze complex clinical and billing information; technical and data competency, strong adaptability and organizational skills. Enthusiastic and self-motivated

Benefits

DHCS is dedicated to creating an innovative workplace for its team members that is inclusive, diverse, and interactive! Here are a few of the ways we stay engaged with our team:

• Continuous and ongoing training
• Diversity, Equity, and Inclusion program activities
• Employee Assistance Program (EAP)

Additionally, as a team member of the State of California, you may be eligible for many benefits, such as:

• Medical, including health, dental, and vision insurance.
• Paid Holidays and vacation/leave
• Defined retirement program
• Savings Plus Program (401(k), 457)
• Medical/Dependent Care Reimbursement Accounts

Full benefits information can be found on CalHR's 

provides more information about our commitment to serving Californians and organizational excellence.

We need your help! Please let us know how you heard about our position by taking this brief optional survey:  .  This survey is not required to be considered for this position.

In addition, DHCS – Audits & Investigations offer:

• Training opportunities to support role
• Upward Mobility

Telework and Salary Information

Telework: 

This position is currently eligible for telework. The amount of telework is at the  discretion of the Department and is subject to change consistent with DHCS’ Telework  Program and Government Code sections 14200 – 14203. Telework is available to  California residents, and proof of residency may be required.

Business travel may be required, and reimbursement considers an employee’s  designated office and residence subject to regulations and bargaining unit contract  provisions. All commute expenses to the reporting location will be the responsibility of  the selected candidate.

The DHCS office location for this position is: Sacramento 

Salary: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. Please reach out to the hiring unit contact listed on this job advertisement for details.

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is optional. It may be included, but is not required.