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 (i.e., Contact Center Branch, Independent Medical Review Branch, Standard Complaint Branch, and Legal Affairs Branch). The incumbent is responsible for providing support to 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, i.e., Evidence of Coverage. The incumbent is responsible for reviewing, researching, and/or gathering clinical information to determine or affirm the appropriate handling of a health plan member complaint by contacting the member, their representatives, and/or health plans. They may also contact other public departments or agencies for information related to the complaint. In addition, the incumbent implements and ensures compliance with the Department’s Strategic Business Plan goals.

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Leave Program (PLP) 2025 agreement:

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.

You will find additional information about the job in the .

Working Conditions

The DMHC has locations in Downtown Sacramento and Rancho Cordova. Both locations are located close to light-rail with various amenities. The incumbent will work in a climate-controlled cubicle and/or office environment with artificial lighting.

This position may be eligible for hybrid telework. The telework schedule is permitted at the operational needs of the Department and is subject to change, consistent with the State Telework Policy and the DMHC’s Telework Policy. All employees who telework are required to be California residents and maintain California residency in accordance with Government Code 14200.

Special Requirements

• The position(s) require(s) a Background Investigation be cleared prior to being hired.
• The position(s) require(s) a(n) Valid RN License to Practice in California License. You will be required to provide a copy of your license prior to being hired.

Licensure Requirements: Possession of 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. The investigation will consist of fingerprinting and an inquiry to the California Department of Justice to disclose criminal records.

Any documents you submit for a job vacancy such as your state application, resume, cover letter, educational transcripts, etc. SHOULD NOT include ANY confidential information. Confidential information that should be excluded or removed from these documents include, but is not limited to, your Social Security Number (SSN), birthday, driver’s license number (unless required), basis of eligibility, examination results, LEAP status, marital status, and age. Confidential information on the first page of applications submitted electronically online, such as Easy ID number, SSN, examination related information, and driver’s license number will automatically be redacted upon submission.

Possession of Minimum Qualifications will be verified prior to interview and/or appointment. If you are using education to meet the minimum qualifications for this position, you must submit a copy of your high school transcripts or college/university transcript(s). Unofficial transcripts may be accepted during the application process; however, submission of official transcripts may be required prior to appointment.

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:

• Should be familiar with DMHC mission, goals, organizational structure and major work programs.
• Must have a demonstrated positive attitude and a commitment to conduct business tactfully, professionally and confidentially with all internal and external customers and contacts.
• Ability and experience in providing quality customer service

• Experience coordinating health care services
• Experience reviewing, analyzing, and resolving consumer complaints
• Experience health care service plan work with grievances and appeals
• Experience in case management, or utilization management
• Experience in acute inpatient hospital case management
• Experience referencing, comprehending and administering law (statutes) and/or regulations

Benefits

Benefit information can be found on the CalHR website and the CalPERS website.

Additional Application Instructions

To be considered for this vacancy, please complete all applicable fields on the application form, including a list or description of previous/current occupational experience in the duties performed section.

Do NOT include your social security number on any submitted documents. If submitting your application via postal mail or in person, please notate RPA: 25-237 and Job Control: JC-519401 on your application.

All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to clearly demonstrate how you meet the Minimum Qualifications for the position on your State Application (STD Form 678). The application should also clearly demonstrate the candidate’s ability to meet the Desirable Qualifications identified in this job advertisement. The Classification Specification for the Nurse Evaluator II, Health Services, is located at the top of this Job Announcement Posting under Minimum Requirements.

Foreign Degrees or Transcripts – Applicants with foreign degrees or transcripts who wish to apply that coursework toward meeting the minimum qualifications of the classification must provide a transcript evaluation that indicates the number of units to which his/her foreign coursework is equivalent. DMHC accepts foreign transcript evaluations that are completed by one of the agencies approved by the California Commission on Teacher Credentialing.

PLEASE NOTE: If you are mailing your application, it must be postmarked by the final filing date. Hand-delivered applications must be submitted no later than 5:00 p.m. on the final filing date. Applications slipped under the door at the Human Resources Office will be stamped the following business day.

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 required and must be included.
• Other - A Cover Letter is Required