Nurse II

Job Overview Functional Title: Nurse II Job Title: Nurse II Agency: Health & Human Services Commission Department: Utilization Review, Waiver & Community Services Regional Management & Maintenance Team Posting Number: 17283 Closing Date: 11/25/2026 Posting Audience: Internal and External Occupational Category: Healthcare Practitioners and Technical Salary Range: $4,801.16 - $7,761.50 monthly Salary Group: TEXAS-B-22 Shift: Day Telework: Eligible for Telework Travel: Up to 75% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Exempt Job Location City: Arlington Job Location Address: 2561 Matlock Rd Other Locations: Abilene; Arlington; Bedford; Dallas; Decatur; Fort Worth; Grand Prairie; Irving; McKinney; Plano; Rockwall; Weatherford MOS Codes: 290X, 46AX, 46FX, 46NX, 46PX, 46SX, 46YX, 66B, 66C, 66E, 66F, 66G, 66H, 66N, 66P, 66R, 66S, 66T, 66W Job Description The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Nurse II. This role contributes to MCS’s mission by ensuring individuals served in our 1915(c) waiver programs and Community Attendant Services (CAS) receive the appropriate type and amount of service. The ideal candidate thrives in an environment that emphasizes teamwork, excellence through high professional standards, personal accountability, continuous learning, critical thinking, and integrity. Under the direct supervision of the Utilization Review Nurse Manager, the Utilization Review (UR) nurse reviews and evaluates individuals’ records, individual service plans (ISPs), patient assessments, documentation related to Title XIX and Title XX, and state plan Medicaid community services for aged and disabled persons and those with intellectual and developmental disabilities (IDD). The UR nurse also conducts face‑to‑face interviews with individuals enrolled in CAS, CLASS, DBMD, HCS, and TxHmL programs to determine service justification. Based on the assessment, the UR nurse uses program knowledge and nursing expertise to determine appropriateness, quality, and cost effectiveness of services, validates determinations of health service needs, and makes service authorization decisions. The UR nurse conducts quality assurance reviews and quality improvement studies, evaluates assigned Level of Need (LON) determinations in IDD waiver programs, and works collaboratively with other UR nurses and regional staff to implement an effective statewide UR program and ensure consistent application of UR policies and procedures. Essential Job Functions Attend work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Conduct desk reviews of required documentation for HHSC Medicaid Long Term Care Waiver Programs and Community Attendant Services (CAS); participate in onsite, televideo, or telephonic interviews of individuals identified in the random sample. Review, evaluate, and document services provided to aged and disabled persons and persons with intellectual disability to validate service needs, determine appropriateness and quality, and assess cost effectiveness of services. (35%) Makes service authorization decisions on difficult, complicated, and/or targeted cases. (20%) Conduct a variety of quality assurance reviews and quality improvement studies, evaluate compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures. (10%) Work collaboratively with other UR nurses through routine and ad hoc meetings to implement an effective statewide UR program and ensure consistent application of policies and procedures. (10%) Develop, provide resources and technical assistance to regional staff and providers. (10%) Testify as the subject matter expert (SME) in Medicaid fair hearings related to appealed service reductions or denials. (5%) Produce routine and specialized data and information for program reports. (5%) Work collaboratively across MCS to identify innovative and effective solutions for clients and staff. (5%) Registrations, Licensure Requirements, or Certifications Licensed as a professional Registered Nurse (RN) in the state of Texas or a state that recognizes reciprocity through the Nurse Licensure Compact. Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a). Valid Texas Driver License. Knowledge, Skills, and Abilities Comprehensive knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health and nursing care principles. Knowledge of quality management, utilization management, health care needs and services for the elderly and disabled. Thorough knowledge of ID and other developmental disability–related conditions, HCS, TxHmL, CLASS, DBMD, CAS, ICF/ID program rules, service array and billing guidelines, local authority functions and waiver service system. Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports. Awareness of federal and state laws relating to long‑term care and other Medicaid and non‑Medicaid services and programs. Knowledge of program planning, implementation and evaluation, and continuous quality improvement. Ability to communicate effectively, both orally and in writing. Ability to interpret statistical information. Ability to multi‑task, handle stress, and meet deadlines. Ability to work collaboratively across MCS to accomplish objectives. Keen attention to detail and ability to implement creative solutions to problems. Able to balance team and individual responsibilities. Proficiency with a personal computer, copier, Microsoft Office suite, and Outlook e‑mail. Travel throughout the state as necessary. Initial Screening Criteria Two‑year experience working as a Registered Nurse (RN). Graduation from an accredited four‑year college or university with major coursework in nursing preferred, or from an accredited nursing program. BSN preferred; experience and education may be substituted for one another. Must meet the federal definition of a Qualified Intellectual and Developmental Disability Professional as defined in 42 Code of Federal Regulations 483.430(a). At least one year of experience working directly with persons with intellectual disability or other developmental disabilities. Ability to travel 75% of the time. Experience in utilization review or quality assurance activities in long‑term services and supports for the aged and disabled preferred. Active Duty, Military, Reservists, Guardsmen, and Veterans Military occupations that relate to the initial selection criteria and registration or licensure requirements for this position may include, but are not limited to, those listed in this posting. All active‑duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at the Texas State Auditor’s Office. ADA Accommodations In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the online application, contact the HHS Employee Service Center at View phone number on click.appcast.io. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview. Pre‑Employment Checks and Work Eligibility Appointed individuals may be required to pass background and other due diligence checks. HHSC uses E‑Verify. You must bring your I‑9 documentation with you on your first day of work. Telework Disclaimer This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs. Benefits Comprehensive benefits package including 100% paid employee health insurance for full‑time eligible employees, a defined benefit pension plan, generous time‑off benefits, and numerous opportunities for career advancement. Markets Nearest Major Market: Arlington, Texas Nearest Secondary Market: Dallas #J-18808-Ljbffr