• Increase Text Icon
  • Decrease Text Icon
  • Email Icon
  • Print this page
You are here: Home . jobs . postings . job18015

Texas Department of Insurance

The Texas Department of Insurance (TDI) is a state agency responsible for both consumers and the insurance industry. We work to fulfill our legislative mandate to regulate the insurance industry, administer the Texas workers’ compensation system, and promote a healthy insurance marketplace, while also protecting the people and the businesses that are served by insurance. We take our responsibility to Texans seriously and strive for excellent customer service through our professional attitude, competence and efficiency.

Important notice: Read before you apply

Veterans’ Preference:

To receive veterans’ preference, applicants must provide at least one the following documents with their State of Texas Application:

  • a copy of the DD 214, member #4;
  • a statement of compensation from the Veterans Benefits Administration; or
  • a copy of the DD 1300.

Applicable Military Occupational Specialty (MOS) codes are included, but not limited to the following: 66N, 66H, 46, 46NX, 46AX

Additional Military Crosswalk information can be accessed at:

http://www.hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_MedicalandHealth.pdf

Current Opportunity: Nurse Review Investigator

Internal/External Posting – TDI Employees and General Public

The Nurse Review Investigator is responsible for investigating complaints, coordinating medical quality reviews and plan-based audits, processing Enforcement referrals for disciplinary action, and coordinating and conducting various review activities to monitor the clinical quality and accuracy of the designated doctor work product. The Nurse Review Investigator is responsible for assisting in the production of the monthly, quarterly, and annual reporting of investigation and review activities. The Nurse Review Investigator may also perform an array of training and program support, to include educating division staff concerning the medical aspects of a designated doctor exam request. This position reports directly to the Director of Health Care Business Management for the Division of Workers’ Compensation.


This position:

  • investigates quality of care complaints, prepares complaint disposition forms, and makes a disposition recommendation using established outcome criteria;
  • manages medical quality reviews and plan-based audits to ensure compliance with the Medical Quality Review Process;
  • monitors the clinical quality and accuracy of the designated doctor work product, and compliance with applicable laws, regulations, policies, and procedures through medical record reviews and review of the injured employee assessments;
  • uses critical thinking skills and professional judgement to identify potential non-compliance concerns;
  • applies appropriate, established screening thresholds (criteria) in monitoring designated doctor reports to develop documented review findings and generate compliance reports for internal referral of case reviews to appropriate staff;
  • assists the Director with planning, developing, implementing and monitoring program operations with quality assurance programs and processes, which includes interpreting, and implementing the statutes, rules, policies, and guidelines of the Designated Doctor Program, the Office of the Medical Advisor and Health Care Quality Review programs;
  • conducts training and educational seminars for staff and assists with medical training and technical assistance to agency staff, injured employees, health care providers, and the medical community as they relate to designated doctor activities;
  • coordinates community outreach and education presentations and facilitates workshops, seminars, and meetings;and
  • performs other related work as assigned.

Qualifications

Graduation from an accredited four-year college or university or from an accredited nursing program.  Education and experience relevant to position requirements may be substituted for one another on a year-for-year basis.   


Additionally, this position requires:

  • a licensed registered nurse in the State of Texas that recognizes reciprocity through the Nurse Licensure Compact; and
  • five years’ of experience of utilization review, quality assurance, risk management, peer review or managed care experience.

Preferences for this position include:

  • experience and/or knowledge in the Texas Workers’ Compensation system; and
  • nurse paralegal certification.

This position requires demonstrated knowledge of:

  • community health and nursing care principles, practices, and procedures;
  • health care laws and regulations;
  • local, state and federal laws and regulations relevant to program areas;
  • program administration and management techniques;
  • statistical analysis processes;
  • program regulations, planning, procedures, and implementation;
  • medical diagnoses and procedures, coding and terminology;
  • accepted medical treatment programs; and
  • utilization review and control measures.

This position requires demonstrated skill in:

  • problem solving, decision making, and planning;
  • oral and written communication
  • instructing others;
  • making oral presentations to groups of various sizes;
  • project management;
  • facilitating workshops and seminars;
  • use of a computer and applicable software; and
  • operating a motor vehicle in highly congested traffic conditions in a safe courteous manner in compliance with traffic laws.

This position requires the demonstrated ability to:

  • gather, assemble, correlate, and analyze facts;
  • apply critical thinking to analyze and solve work problems;
  • interpret policies and procedures as well as health care regulations;
  • develop project plans, formulate learning and training objectives;
  • evaluate the effectiveness of training and recruiting;
  • assess training and recruiting needs;
  • communicate professionally and effectively, both verbally and in writing, with all levels of employees and the general public;
  • plan, assign, and/or supervise the work of others; and
  • satisfy the conditions required to maintain fully-qualified driving status.

Position Details

Opening Date:09/15/2017
Functional Title:Nurse Review Investigator
Classification Title:Nurse IV
Status:Internal/External Posting – TDI Employees and General Public
Application Deadline:Until Filled
Pay Group:B23
Monthly Salary: $5,416.00
Annual Salary:$64,992.00
Job Posting Number:18-015
Division:Division of Workers’ Compensation/Health Care Quality Review
Location:7551 Metro Center Drive, Ste. 100, Austin, TX 78744
Travel Required:5 %

 

For more information, contact:

Last updated: 09/15/2017

Contact Information and Other Helpful Links