Nurse III

About the role

Under the general direction of the Policy and Program Branch Manager, performs advanced (senior-level) nursing work in a consultative, advisory, educational, and administrative capacity in relation to services for people with special health care needs. Work involves developing policy, procedures, guidelines, and standards of care for the programs administered by Specialty Health. This position supports the Children with Special Health Care Needs (CSHCN) Services Program, the Kidney Health Care (KHC) program, and the Hemophilia Assistance Program (HAP). This position may provide consultative assistance to additional programs within the office. Serves as a resource and participates in inter- and intra-agency workgroups and meetings. Works under limited supervision, with considerable latitude for the use of initiative and independent judgement. Applicants should ensure that their resumes clearly demonstrate relevant experience and skill sets for consideration.

Essential Job Functions

• Assists with the development of policies, procedures, guidelines, and standards of care for the CSHCN Services Program. May consult on other public health programs supported by the Specialty Health office. This may include examination of current standards of care; exploration of programs, policies, and trends in other states; research, data collection, evaluation of payment/reimbursement methodologies, and examination of the potential impact of changes on the existing system. Interfaces with the claims contractor and HHSC Medicaid/CHIP benefits staff on issues related to policy development. Provides technical assistance and expert consultation to other staff involved in the policy development process. (EFJ #1 - 25%)
• Participates in state level planning and development of systems of care for persons with special health care needs and their families. Works with office staff to coordinate activities related to planning, development, and redesign of systems of care for CSHCN, KHC, and HAP clients. Tracks and monitors legislation related to medical policy within Specialty Health programs. (EFJ #2 - 20%)
• Participates in the urgent need determination process. Assures that any needed clinical follow-up is accomplished in a timely manner. Reviews, researches, and adjudicates other Specialty Health program medical reviews related to eligibility, authorizations, claims payment, and appeals. Consults with Regional and Central Office staff on programmatic issues. Participates in agency quality review activities including consultative feedback and periodic review and revision of the CSHCN standards for review. Participates in review of proposals for CSHCN contracts. (EFJ #3 - 20%)
• Represents Specialty Health and the Texas Health and Human Services Commission (HHSC) on cross-functional and cross-agency workgroups, task forces, and councils related to children and adults with special health care needs. Works with other teams across the SH area, including the Operations and Support Services, Client Services, Administrative Services, Reimbursements, and additional program teams. Consults with professional, advocacy, and consumer groups to address issues related to populations served by programs within the office. May make presentations to HHSC staff and the public. Participates in special projects related to these populations and other health issues. (EFJ #4 - 15%)
• Writes, reviews, revises, and edits policy content of program publications including the Program Provider Manuals, Provider Bulletins, Family Newsletters, and other program client and provider communications. Ensures accuracy of content, readability, and understandability of the materials. (EFJ #5 - 15%)
• Other duties as assigned. (EFJ #6 - 5%)

Registrations, Licensure Requirements or Certifications

Must be licensed as a Registered Nurse in Texas or a state that recognizes reciprocity through the Nurse Licensure Compact.

Knowledge, Skills and Abilities

• Knowledge of professional nursing, nursing techniques, and public health administration; health care service delivery systems for children and adults (i.e., CSHCN, KHC, HAP, Medicare, Medicaid, and Children's Health Insurance); medical diagnoses, procedures, and accepted medical treatment programs; universal diagnosis and procedure coding systems, such as the International Classifications of Diseases Tenth Revision and Eleventh (ICD-10 / ICD-11) and the Health Care Financing Administration Common Procedure Coding System (HCPCS) and issues related to reimbursement and pricing; claims processing; human services, community health, and nursing care principles, practices, and acceptable professional standards of patient care; population-based health outcomes measurement and health delivery systems, including managed care; utilization review and control measures; issues related to persons with chronic illness; principles of cultural competency and diversity awareness.
• Skill in the care and treatment of patients; the operation of computers and applicable computer software (including electronic mail systems, Microsoft Office suite, Internet Explorer); online research using medical databases; developing and/or writing clear, concise policies, instructions, guidelines, and procedures; making verbal presentations and representing SH programs to the public; developing and/or writing clear, concise policies, instructions, guidelines, and procedures; and effective leadership.
• Ability to prepare and maintain records; explain public health laws; organize, coordinate, and evaluate nursing activities and delivery of public health services; interpret policies and procedures; interpret health care regulations and recognize patterns of medical necessity treatment; assign and/or supervise the work of others; gather, correlate, and analyze facts and data and interpret medical professional literature; organize and analyze complex workloads; plan and organize short-term and long-range assignments and objectives; manage multiple and diverse tasks/projects; work effectively with groups of people and coordinate diverse program activities; and express oneself clearly both verbally and in writing.

Initial Screening Criteria

• Two (2) years of experience evaluating policy and/or procedure development or improvement activities.
• At least one (1) year's experience in Texas Health and Human Services operations preferred.

Military

Military occupation(s) 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.

Additional Information

Salary Range: $5,425.33 - $7,155.75 monthly (Pay Frequency: Monthly; Salary Group: TEXAS-B-24). Shift: Day, Days (First). Telework; Travel: Up to 10%. Regular, full-time, FLSA Exempt. Job Location: 701 W 51st St, Austin, TX. Posting Number: 21389. Closing Date: 09/25/2026. This position may be eligible for telework; all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.