What are the responsibilities and job description for the Hearings Officer V position at Health & Human Services Comm?
Hearings Officer V
Performs senior-level legal and medically technical work related to fair hearings which must be conducted by a nurse. Work involves overseeing and presiding over a high volume of medically critical fair hearings and reviewing medically critical fair hearing decisions to ensure quality and accuracy. Supervises the work of other hearings officers. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment with regard to fair hearing activities.
Performs senior-level legal and medically technical work related to fair hearings which must be conducted by a nurse. Work involves overseeing and presiding over a high volume of medically critical fair hearings and reviewing medically critical fair hearing decisions to ensure quality and accuracy. Supervises the work of other hearings officers. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment with regard to fair hearing activities.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Oversees and presides over a high volume of medically critical and complex Medicaid fair hearings, under minimal supervision, on matters requiring interpretation and application of a diverse array of state and federal laws and regulations, which must be heard by a registered nurse or a licensed vocational nurse, including legislatively sensitive cases such as private duty nursing reductions and denials and medical necessity denials for medically dependent children. This may also include fair hearings related to medical necessity denials for adults, home health skilled nursing, hospitalizations, durable medical equipment, medications, and acute care medical procedures. Overseeing and presiding over fair hearings includes conducting and controlling the hearing, recording the hearing; admitting, evaluating, and interpreting evidence, including sworn testimony, and appropriately applying law regarding procedural matters raised in hearings; requesting policy and legal clarifications, when necessary; and developing the hearing record by asking relevant questions. (40%)
Oversees, coordinates, and completes hearing-related activities using initiative and independent judgment to include maintaining a hearing docket and ensuring adequate and advanced notice is given when appropriate in order to uphold due process rights; preparing for hearings; holding pre-hearing conferences; determining good cause; determining jurisdiction; ruling on motions; determining credibility and weighing evidence to determine whether burden of proof regarding the medical eligibility of appellants is met; sending emails and letters to various internal and external stakeholders; and writing and rendering legally sufficient hearing decisions which includes considering testimony and evidence, including complex medical records and nursing notes, preparing findings of facts and conclusions of law, and writing orders establishing clear and concise instructions to the agency. (30%)
Supervises the work of other hearings officers, to include training and mentoring hearings officers; regulating the types of cases assigned; observing hearings; reviewing hearing decisions to ensure compliance with policies, rules, and regulations and to ensure the medical needs of the appellants are taken into consideration; providing feedback to the hearings officers and their managers; and adjusting assignments as needed. This supervision, training, and mentoring is crucial to the new hearings officers. It is highly important that they understand the appropriate role and expected conduct of an administrative judge and the duties required to prepare for and conduct a fair hearing as they will be making important decisions regarding the care and services of medically fragile children and adults. It is also of particular importance that the medically critical hearing decisions are reviewed by Nurse Hearings Officers as they may be presented to the court upon judicial review. (30%)
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Oversees and presides over a high volume of medically critical and complex Medicaid fair hearings, under minimal supervision, on matters requiring interpretation and application of a diverse array of state and federal laws and regulations, which must be heard by a registered nurse or a licensed vocational nurse, including legislatively sensitive cases such as private duty nursing reductions and denials and medical necessity denials for medically dependent children. This may also include fair hearings related to medical necessity denials for adults, home health skilled nursing, hospitalizations, durable medical equipment, medications, and acute care medical procedures. Overseeing and presiding over fair hearings includes conducting and controlling the hearing, recording the hearing; admitting, evaluating, and interpreting evidence, including sworn testimony, and appropriately applying law regarding procedural matters raised in hearings; requesting policy and legal clarifications, when necessary; and developing the hearing record by asking relevant questions. (40%)
Oversees, coordinates, and completes hearing-related activities using initiative and independent judgment to include maintaining a hearing docket and ensuring adequate and advanced notice is given when appropriate in order to uphold due process rights; preparing for hearings; holding pre-hearing conferences; determining good cause; determining jurisdiction; ruling on motions; determining credibility and weighing evidence to determine whether burden of proof regarding the medical eligibility of appellants is met; sending emails and letters to various internal and external stakeholders; and writing and rendering legally sufficient hearing decisions which includes considering testimony and evidence, including complex medical records and nursing notes, preparing findings of facts and conclusions of law, and writing orders establishing clear and concise instructions to the agency. (30%)
Supervises the work of other hearings officers, to include training and mentoring hearings officers; regulating the types of cases assigned; observing hearings; reviewing hearing decisions to ensure compliance with policies, rules, and regulations and to ensure the medical needs of the appellants are taken into consideration; providing feedback to the hearings officers and their managers; and adjusting assignments as needed. This supervision, training, and mentoring is crucial to the new hearings officers. It is highly important that they understand the appropriate role and expected conduct of an administrative judge and the duties required to prepare for and conduct a fair hearing as they will be making important decisions regarding the care and services of medically fragile children and adults. It is also of particular importance that the medically critical hearing decisions are reviewed by Nurse Hearings Officers as they may be presented to the court upon judicial review. (30%)
Knowledge Skills Abilities:
Knowledge of Medicaid policy, principles, and practices; and of Medicaid laws, regulations, and rules related to HHSC programs.
Skill in editing, writing, and analysis.
Ability to conduct sensitive Medicaid hearings, write clear and concise earing decisions, conduct research, summarize findings, interpret and apply Medicaid law and policy, use legal reference materials, communicate effectively, and train others.
Knowledge of Medicaid policy, principles, and practices; and of Medicaid laws, regulations, and rules related to HHSC programs.
Skill in editing, writing, and analysis.
Ability to conduct sensitive Medicaid hearings, write clear and concise earing decisions, conduct research, summarize findings, interpret and apply Medicaid law and policy, use legal reference materials, communicate effectively, and train others.
Registration or Licensure Requirements:
Must be licensed to practice as a licensed vocational nurse, licensed practical nurse, or registered nurse in the state of Texas or a state that recognizes reciprocity through the Nurse Licensure Compact.
Must be licensed to practice as a licensed vocational nurse, licensed practical nurse, or registered nurse in the state of Texas or a state that recognizes reciprocity through the Nurse Licensure Compact.
Initial Selection Criteria:
Two years' experience as LVN/LPN/RN understand and follow directions is required.
Experience in fair hearings, experience in analyzing and interpreting policy, experience with people from diverse backgrounds and conduct effective interviews, experience in composing clear and concise written documents is preferred.
Two years' experience as LVN/LPN/RN understand and follow directions is required.
Experience in fair hearings, experience in analyzing and interpreting policy, experience with people from diverse backgrounds and conduct effective interviews, experience in composing clear and concise written documents is preferred.
Additional Information:
The position may be housed in Abilene or Lubbock.
The position may be housed in Abilene or Lubbock.
MOS Code:
There are no direct military occupations that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
There are no direct military occupations that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
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