Nurse Policy Analyst

Brief Job Description

The Nurse Policy Analyst (Nurse IV) position reports to the Medical Benefits Policy Manager in the Office of Program and Policy, Medicaid and CHIP Services Department. The Nurse Policy Analyst (Nurse IV) will lead internal workgroups and projects, and mentor other staff. This position performs complex analysis of medical benefits for the Medicaid/CHIP Policy Development Division.

Essential Job Functions

• (30%) Clinical Review of the Literature - Researches, analyzes, and synthesizes peer reviewed literature and evidence-based practices and applies it to program medical, dental, and mental health benefit policy. Provides complex technical medical information verbally or in writing to nonclinical audiences. Consults with stakeholders to address Medicaid program benefit policy issues.
• (30%) Develops policies - Reviews and updates current benefits and develops new benefits for Medicaid medical policy. Identifies eligibility standards and authorization requirements for benefit policy. Collaborates, as needed, with Medical Benefits staff as well as HHSC staff in other programs and other State agencies for program benefit policy development, planning, and implementation. Serves as clinical subject matter expert in the development and review of program benefit policy. Develops, reviews, and provides comments on Medicaid materials intended for use by vendors, providers, managed care organizations, and other partners, as well as stakeholders.
• (25%) Special Projects and Workgroups - Leads or participates in workgroups and public meetings engaged in research, analysis, and evaluation of policy issues or initiatives. Leads or participates in special projects as requested by management. Positively represents department, agency, and State in conferences and meetings, including public presentation delivery, and, as an ongoing representative on various committees and teams, as directed. Prepares project updates, summaries, reports, or other documents and keeps management informed on pertinent issues. Functions as a resource to other State staff providing guidance, advice, or direction, and synthesizes medical and dental benefit policy langauge, including during legislative session where this position may be expected to serve in a lead role. Responds to internal and external communications and requests for information in a timely manner. Identifies the need to, and communicates and consults with external stakeholders, as necessary.
• (15%) Quality Assurance and Process Improvement - Identifies methods for effectively managing benefit changes that have varying effective dates. Researches provider or manufacturer questions or concerns. Maintains organized electronic files of activities and shares with staff and partners, as appropriate. Reviews, analyzes, and comments on regulations affecting program benefit policy. Other duties, as assigned, include but are not limited to actively participating in or serving in a supporting role to meet the agency's obligations.

Registrations, Licensure Requirements or Certifications

Requires current license to practice as a Registered Nurse (RN) in Texas or a state that recognizes reciprocity through the Nurse Licensure Compact.

Knowledge, Skills, and Abilities

• Strong research skills including experience conducting comprehensive literature reviews using electronic databases such as PubMed/Medline, Hayes, or other similar electronic sources such as UpToDate, and reviewing professional organization’s recommendations for best practices.
• Experience evaluating the quality and levels of evidence presented in the literature. Must be able to synthesize findings for clinical and non-clinical audiences. Experience with clinical practice guideline evaluation or development; clinical quality assessment, assurance, or improvement; clinical research or health care delivery.
• Ability to mentor and work well with others.
• Ability to work collaboratively and adapt quickly to changing circumstances and team dynamics, and take on a lead role as needed.
• Knowledge of Health and Human Services agencies and programs, including Medicaid/CHIP. Excellent computer skills, including Microsoft Office suite.
• Demonstrated ability to work independently and function effectively as a member of a team, and under tight deadlines with high volume workloads.
• Highly organized and the ability to manage several projects concurrently in a fast-paced environment and juggle competing priorities.
• Detail and task oriented.
• Excellent written, verbal, and interpersonal communication and presentation skills.
• Ability to effectively facilitate meetings, and establish and advance agenda goals.
• Skill in project planning, evaluation, and implementation.
• Skill in establishing and maintaining effective working relationships with managers, co-workers, and other staff or program stakeholders.
• Knowledge of quality assurance principals.
• Familiarity with medical vocabularies such as Current Procedural Terminology (CPT) and International Classification of Diseases (ICD), version 10 is a plus.
• Skills in effective interpersonal communication and ability to collaborate across a variety of business areas and with staff at multiple levels of experience and expertise.
• Skills in active listening, asking questions, providing constructive/collaborative feedback, building trust, and setting SMART goals.
• Skills in identifying problems, evaluating alternatives, and proposing effective solutions.
• Ability to effectively plan and work cooperatively in a rapid-paced, deadline-oriented environment.