Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage. Functional Title: Nurse II Job Title: Nurse II Agency: Health & Human Services Comm Department: UR Wav & Comm Srvs Ran Mmt St Posting Number: 13275 Closing Date: 03/31/2026 Posting Audience: Internal and External Occupational Category: Healthcare Practitioners and Technical Salary Group: TEXAS-B-22 Salary Range: $4,801.16 - $7,761.50 Pay Frequency: Monthly Shift: Day Additional Shift: Telework: Eligible for Telework Travel: Up to 75% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Exempt Facility Location: Job Location City: DENTON Job Location Address: 3612 E MCKINNEY ST RM 342-343 Other Locations: Austin; Georgetown; Longview; Marshall; San Antonio; Temple; Tyler; Waco MOS Codes: 290X,46AX,46FX,46NX,46PX,46SX,46YX,66B,66C,66E,66F,66G,66H,66N,66P,66R,66S,66T,66W Nurse II 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. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution 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 to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy. Under the direct supervision of the Utilization Review Nurse Manager, the utilization review (UR) nurse: reviews and evaluates individual's 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 individuals with intellectual and developmental disabilities (IDD); and conducts face to face interviews with individuals enrolled in the Community Attendant Services (CAS), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS), and Texas Home Living (TxHmL) programs to determine service justification. Based on the in-person, teleconference or telephone interview assessment, desk review and evaluation of services, the UR nurse uses program knowledge and nursing expertise to determine appropriateness and quality of services, cost effectiveness of the service plan, validates determinations of health service needs, and makes service authorization decisions. The UR nurse conducts a variety of quality assurance reviews, and quality improvement studies. The UR nurse evaluates assigned Level of Need (LON) determinations in the IDD waiver programs when assigned to do so. This position works collaboratively with other UR nurses and regional staff to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently. This position works under the general supervision of the UR Nurse Manager, with moderate latitude for use of initiative and independent judgment. Essential Job Functions: Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Conducts desk reviews of required documentation for Health and Human Services Commission (HHSC), Medicaid Long Term Care Waiver Programs and Community Attendant Services (CAS). Participates in onsite, televideo, or telephonic interviews of the individuals identified in the random sample. Reviews, evaluates, and documents services provided to aged and disabled persons and persons with intellectual disability to validate service needs, service provision, determines appropriateness, quality, and cost effectiveness of services. (35%) Makes service authorization decisions on difficult, complicated, and/or targeted cases. (20%) Conducts a variety of quality assurance reviews and quality improvement studies and evaluates compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures. (10%) Works collaboratively with other UR nurses through routine and ad hoc meetings to implement an effective statewide UR program and to ensure UR policies and procedures are applied consistently. (10%) Develops, provides resources and technical assistance to regional staff and providers. (10%) Testifies as the Subject Matter Expert (SME) in Medicaid fair hearings related to appealed service reductions or denials. (5%) Produces routine and specialized data and information for program reports. (5%) Works collaboratively across MCS to identify innovative and effective solutions for clients and staff (5%) Registrations, Licensure Requirements or Certifications: Must be 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) required. Must have a valid Texas Driver License. Knowledge Skills Abilities: Meets the criteria for designation as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required. Knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health and nursing care principles, quality management, utilization management, health care needs and services for elderly and disabled. Thorough knowledge of ID and other developmental disability related conditions, HCS, TxHmL, CLASS, DBMD, CAS, and 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. A keen attention to detail and the ability to implement creative solutions to problems. Able to balance team and individual responsibilities. Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports. Ability to: explain and interpret applicable health laws, rules, standards, and regulations; recognize patterns of medical necessity treatment, fraud, abuse, and neglect; use 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 course work 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). Must have at least one year of experience working directly with persons with intellectual disability or other developmental disabilities. Must be able 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. Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC. Active Duty, Military, Reservists, Guardsmen, and Veterans: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but 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 Texas State Auditor's Office - Job Descriptions. 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 on-line application, contact the HHS Employee Service Center at 1-888-894-4747. 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: Depending on the program area and position requirements, applicants selected for hire 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. Download the I-9 Form 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.

Responsibilities The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with Valley Hospital Medical Center in 1979, the Valley Health System has grown to include Centennial Hills Hospital Medical Center, Spring Valley Hospital Medical Center, Summerlin Hospital Medical Center , Henderson Hospital, and Valley Health Specialty Hospital. Benefit Highlights: - Competitive Compensation & Generous Paid Time Off - Excellent Medical, Dental, Vision and Prescription Drug Plans - 401(K) with company match and discounted stock plan - Career opportunities within VHS and UHS Subsidies - Challenging and rewarding work environment - Comprehensive education and training center Job Description: Responsible for preparing statistical reports, coding diseases and operations according to accepted classification systems and maintaining indices according to established policies and procedures. Qualifications ACUTE INPATIENT EXPERIENCE REQUIRED Education: Graduate as a Registered Health Information Administrator (RHIA) or a Registered Health Information Technician (RHIT) from an approved program by the American Health Information Management Association (AHIMA) preferred. Experience: Minimum 3 years recent Inpatient and Outpatient coding experience required. Coders must have the ability to crossover between all coding types (IP, OP, ASC, ER) and maintain a 95% coding accuracy across the board. -One to three years coding experience in an acute care setting—including inpatient, outpatient and ambulatory surgery. Technical Skills: Computer proficiency, analytical skills, ICD 9-CM/CPT coding knowledge. License/Certification: Credentialed as RHIT/RHIA or CCS required Other: Demonstrated knowledge of coding procedures, extensive reimbursement system knowledge, written and verbal communication skills. Must possess excellent knowledge of medical terminology, anatomy, physiology, and pathophysiology. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Notice At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

Role Description The ERS Mapping Specialist is responsible for configuring, maintaining, and optimizing electronic remittance advice (ERA/835) mapping within the IMAGINE platform to enable accurate and timely automated payment posting. This role ensures payer payment, adjustment, denial, and patient responsibility data are correctly interpreted and translated into system rules that support clean electronic posting, minimize manual intervention, and maximize revenue cycle efficiency. The specialist serves as a subject matter expert for remittance structure, reimbursement methodologies, and mapping accuracy while maintaining documentation and driving continuous improvements to posting performance. Essential Functions and Tasks - Configure and maintain ERA/835 remittance mapping rules to support automated payment posting. - Interpret Explanation of Benefits (EOBs), payer methodologies, and remittance data elements to ensure accurate financial outcomes. - Validate and test mapping logic for payments, contractual adjustments, denials, and patient responsibility. - Edit and update mapping rules as payer formats or reimbursement methodologies change. - Generate correction and exception reports to identify posting issues and root causes. - Investigate and resolve mapping errors impacting revenue or posting accuracy. - Maintain and update ERS Mapping Process Guide and related documentation. - Partner with Posting, Enrollment, and Revenue Cycle teams to ensure alignment on payer requirements. - Support continuous improvement initiatives to increase automation rates and reduce manual posting. - Escalate systemic issues or payer anomalies to leadership with recommended solutions. - Perform other duties as assigned in support of ERA/EDI optimization efforts. Qualifications - Bachelor’s Degree. - 1+ year experience in medical billing or revenue cycle operations required. - Experience with ERA/835 remittance processing or electronic payment posting preferred. - Knowledge of medical terminology and coding concepts required. - Familiarity with third-party payer billing and reimbursement processes required. Requirements - Strong understanding of ERA/835 remittance structures and payment logic. - Ability to interpret EOBs and payer reimbursement methodologies. - High attention to detail and accuracy in rule configuration. - Analytical and problem-solving skills with ability to diagnose posting discrepancies. - Ability to work independently in a fast-paced production environment. - Strong organizational and documentation skills. - Effective written and verbal communication skills. - Proficiency with Microsoft Office Suite and standard RCM systems. Travel - Remote - Not required unless specifically requested in service of a particular client. Compensation - Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. - This position is also eligible for a discretionary incentive bonus in accordance with company policies.

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a talented individual for a DRG Nurse Quality Auditor, Sr. Specialist who is responsible for performing on-going quality assurance audits of the accuracy and consistency of work performed by clinical and coding staff. Responsibilities include performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS code assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have extensive clinical experience and an active coding certification with a background in auditing medical records with a high level of understanding payment methodologies including MS-DRG, and APR-DRG. What you will do - Conducts QA audits to ensure accurate determinations and high-quality documentation. - Identifies quality trends and develops corrective education and training. - Reviews medical records for accurate coding, compliance, and guideline adherence. - Applies job aids, policies, and criteria consistently during reviews. - Documents review decisions clearly for reporting and trending. - Meets productivity and quality standards while completing all review elements accurately. - Supports and trains new reviewers, coders, or clinical DRG auditors as needed. - Demonstrates strong knowledge of payment methodologies, DRG validation, and client-specific requirements. - Maintains current knowledge of coding guidelines, licensure, and CEU requirements. - Participates in trainings, cross-trains on claim types, and supports projects, analysis, and reporting. - Serves as a subject matter expert as needed. What we're looking for - Associates degree required; bachelor’s degree preferred. - Active, unrestricted RN licensure from the United States and in the state of primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required - One of the following Coding Certifications required: RHIA, RHIT, CCS, CIC, CCDS or CPC - 5+ years clinical experience in an inpatient hospital setting required - 3+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies - Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) - Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance. - Demonstrated ability to apply clinical review judgment to make clinical determinations - Excellent written communication skills including ability to write clear, concise, accurate, and fact-based rationales in support of review determinations. - Advanced knowledge of medical codes, coding conventions and rules. - Demonstrated experience in medical review, chart audits and quality improvement processes. What you should expect in this role - Remote within the U.S. - 0–10% travel required Applications for this posting will be accepted until April 24, 2026. The pay range for this position is $80,600.00 - $115,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.