Nurse Evaluator II

Job Description and Duties The DMHC Help Center educates members about their health care rights and resolves complaints against health plans to ensure a stable and accessible health care delivery system. Under the direction of the Nurse Evaluator IV, the incumbent is responsible for providing clinical and professional support for all offices of the Help Center, including the Contact Center Branch, Independent Medical Review Branch, Standard Complaint Branch, and Legal Affairs Branch. The incumbent supports staff on issues related to health care member complaints filed with the DMHC pursuant to the Knox‑Keene Health Care Service Plan Act of 1975, Title 28 of the California Code of Regulations, and health plan member contracts. They review, research, and gather clinical information to determine or affirm the appropriate handling of a health plan member complaint, contacting the member, their representatives, and/or health plans. They may also contact other public departments or agencies for related information. Additionally, the incumbent implements and ensures compliance with the Department’s Strategic Business Plan goals. Position Details Job Code: JC-519401 Position #s: 409-161-8144-006 Working Title: Nurse Evaluator II Classification: NURSE EVALUATOR II, HEALTH SERVICES Salary: $7,430.00 - $9,757.00 # of Positions: 1 Work Location: Sacramento County Telework: Hybrid Job Type: Permanent, Full Time Special Requirements and Qualifications Background investigation required prior to hiring. Valid RN license to practice in California required; a copy of the license must be provided before hiring. Possession of a valid California Registered Nurse license. Minimum Requirements Must possess a valid license to practice as a professional registered nurse in California. All applicants not currently employed by the DMHC will be subject to a pre‑employment background investigation, including fingerprinting and an inquiry to the California Department of Justice. Desirable Qualifications Familiarity with DMHC mission, goals, organizational structure, and major work programs. Demonstrated positive attitude and commitment to conduct business tactfully, professionally, and confidentially with all internal and external customers and contacts. Experience providing quality customer service. Experience coordinating health care services. Experience reviewing, analyzing, and resolving consumer complaints. Experience with health care service plan work involving grievances and appeals. Experience in case management or utilization management. Experience in acute inpatient hospital case management. Ability to reference, comprehend, and administer law (statutes) and/or regulations. Benefits Benefit information can be found on the CalHR website and the CalPERS website. Equal Opportunity Employer The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation. It is an objective of the State of California to achieve a drug‑free workplace. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants. #J-18808-Ljbffr California Department of Managed Health Care