Job Posting: Coding & Medical Policy Evaluator

Department of Health Care Services

JC-497058
-
Coding & Medical Policy Evaluator
NURSE EVALUATOR II, HEALTH SERVICES

$7,430.00 - $9,757.00 per Month
New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.

Final Filing Date: 11/14/2025

Job Description and Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today!

About this Role:
Under direction of the Staff Services Manager II (SSM II), the Nurse Evaluator II applies medical knowledge to monitor and evaluate provider claiming patterns, monitor implementation and performance of medical policy in the claims processing system, and recommended appropriated action based on the facts obtained. Assists in the development and implementation of new or revised Medi-Cal and Public Health Medical Policy. Prepares reports for management review and approval. The incumbent must possess professional nursing experience, a high degree of initiative, independent and critical thinking, written and oral communication skills, workload prioritization, and time management skills; attention to detail and follow-through is imperative.

 

Have questions and/or need assistance? Contact Recruit@dhcs.ca.gov, we are here to help walk you through the state hiring process!

Interviews may be conducted via video conference (Microsoft Teams, WebEx, or Skype) or by telephone.  More information will be provided to candidates that are invited for an interview. It is highly recommended that you submit your application electronically via your CalCareer Account.

This recruitment has been posted for more vacancies than currently exist as it may be used to fill additional identical vacancies which occur within 180 days of the closing date of this bulletin.

If you are interested in this position, it is critical to review the Classification Specifications to determine if you will meet the minimum qualifications (MQ’s). Please make note of Education and Experience requirements for the classification.

This position is subject to the Department’s Conflict of Interest Code and requires annual filing of a Statement of Economic Interests (Form 700).

This position is being re-advertised. If you previously applied under JC-491596, you must re-apply to JC-497058 in order to be considered.


You will find additional information about the job in the Duty Statement.

Working Conditions

Please see Telework Information section below for telework details.

This work location is very convenient!  The CA-MMIS Division is located in West Sacramento near IKEA and Walmart. There are several restaurants and fast-food locations nearby, with Starbucks within walking distance. This location has easy access to I-80 and has FREE parking!

The incumbent works in an office setting with artificial light and temperature control. The ability to use a personal computer and telephone is essential. The incumbent must be able to frequently remain in a stationary position at a workstation throughout the day and must occasionally position self to perform a variety of tasks including retrieval of files.

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

Additional Documents

Position Details

Job Code #:
JC-497058
Position #(s):
803-395-8144-XXX
Working Title:
Coding & Medical Policy Evaluator
Classification:
NURSE EVALUATOR II, HEALTH SERVICES
$7,430.00 - $9,757.00
New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.
# of Positions:
Multiple
Work Location:
Yolo County
Telework:
Hybrid
Job Type:
Permanent, Full Time

Department Information

DHCS’ purpose is to provide equitable access to quality health care leading to a healthy California for all.

 

DHCS is a dynamic organization with ambitious goals and talented, committed employees. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians. DHCS is committed to addressing disparities within our organization and in our communities through efforts toward greater diversity, equity, and inclusion. This is accomplished, in part, by a commitment toward employing a diverse workforce that reflects the many communities we serve, and by promoting and enforcing equal employment opportunity.

 

The California Medicaid Information System (CA-MMIS) Operations Division is responsible for oversight of the Medi-Cal Fiscal Intermediary (FI) contractors, who provide Business Operations and Information Technology Maintenance and Operations services. CA-MMIS is a large, highly automated, complex, and interrelated data processing system, which depends on the operation of a large data center by the FI contractor. The CA-MMIS is a mission-critical system to the Department of Health Care Services (DHCS) and the State of California.  This system annually processes and adjudicates medical claims that result in approximately $22 billion annually in payments to health care providers.

 

The CA-MMIS Operations Division is located on Stillwater Road in West Sacramento.

Special Requirements

A Statement of Qualifications (SOQ) is REQUIRED.  Please see Special Requirements Section above for instructions on how to prepare your SOQ.

The SOQ is a narrative discussion of how the candidate's education, training, experience, and skills qualify them for the position. The DHCS may not consider applicants who fail to provide an SOQ with their application. Please use the Knowledge and Desirable Qualifications listed above as a guide when preparing the SOQ. The SOQ serves as documentation of each candidate's ability to present information clearly and concisely in writing. Artificial Intelligence (AI) generated responses will not be accepted for the SOQ assignment, as the purpose for this evaluation is to assess your personal writing and communication skills and abilities. The SOQ should be typed with 12 point Arial font, single-spaced, with your first and last name in the top right corner, no more than two (2) pages in length, and provide the written question or number to label each response. Candidates who do not complete and submit an SOQ may not be considered for the position. When preparing your SOQ please respond to the following:

 

  1. Please describe the extent of your knowledge of health care national coding systems national coding systems. Please include a brief description of any related work experience you may have undertaken.
  2. Please describe your training, knowledge, and any experience you have had in working with large data sets and data analysis.

 

Candidates must meet the Minimum Qualifications as outlined in the Class Specifications.  Please use the link in the announcement, located under Minimum Requirements, to view the Class Specifications.  If you are using education to meet the minimum qualifications (MQ’s) please attach a copy of your degree and transcripts.   If you are not using your education to meet the MQs, you will have the ability to bypass the request.

Individuals who are currently in the classification, eligible for lateral transfer, eligible for a reinstatement, have list eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available).  SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the even no SROA or Surplus candidates apply. 

Application Instructions

Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application.

Final Filing Date: 11/14/2025

Who May Apply

Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply.

Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).

How To Apply

Complete Application Packages (including your Examination/Employment Application (STD 678) and applicable or required documents) must be submitted to apply for this Job Posting. Application Packages may be submitted electronically through your CalCareer Account at www.CalCareers.ca.gov. When submitting your application in hard copy, a completed copy of the Application Package listing must be included. If you choose to not apply electronically, a hard copy application package may be submitted through an alternative method listed below:

Address for Mailing Application Packages

You may submit your application and any applicable or required documents to:

Department of Health Care Services
Mailing
Attn: Certification Technician
M.S. 1300
P.O. Box 997411
Sacramento, CA 95899-7411

Address for Drop-Off Application Packages

You may drop off your application and any applicable or required documents at:

Department of Health Care Services
Drop-Off
1501 Capitol Avenue, Suite 71.1501
Sacramento, CA 95814
08:00 AM - 05:00 PM

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

  • Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at www.CalCareers.ca.gov. All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
  • Resume is required and must be included.
  • Statement of Qualifications -

    A Statement of Qualifications (SOQ) is REQUIRED.  Please see Special Requirements Section above for instructions on how to prepare your SOQ.

Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:
  • Ability to engage team effectively.
  • Ability to develop and maintain effective and cooperative working relationships.
  • Ability to easily adapt to changing priorities.
  • Knowledge of Medi-Cal policy and regulations.
  • Familiarity with the Health Care Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding – from both the State of California and Federal Medicaid perspectives.
  • Familiarity with the Health Insurance Portability and Accountability Act (HIPAA) – from both the State of California and Federal perspectives.
  • Ability to communicate with and bridge relationships among medical, non-technical program and technical staff related to system development projects.
  • Confidence to interact with senior-level and high-level entities in medical/technical fields.

 

Benefits

DHCS is dedicated to creating an innovative workplace for its team members that is inclusive, diverse, and interactive! Here are a few of the ways we stay engaged with our team:

  • Continuous and ongoing training
  • Diversity, Equity, and Inclusion program activities
  • Employee Assistance Program (EAP)

Additionally, as a team member of the State of California, you may be eligible for many benefits, such as:

  • Medical, including health, dental, and vision insurance
  • Paid Holidays and vacation/leave
  • Defined retirement program
  • SavingsPlus Program (401(k), 457)
  • Medical/Dependent Care Reimbursement Accounts

Benefit information may be obtained by visiting: California State Civil Service Employee Benefits Summary - CalHR.

DHCS 2023-2027 Strategic Plan provides more information about out commitment to serving Californians and organizational excellence.

We need your help! Please let us know how you heard about our position by taking this brief optional survey: SurveyMonkey link. This survey is not required to be considered for this position.



Benefit information can be found on the CalHR website and the CalPERS website.

Contact Information

The Hiring Unit Contact is available to answer questions regarding the position or application process.

Hiring Unit Contact:
RandyGee Woodyard
(916) 954-1031
Randy.Woodyard@dhcs.ca.gov

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

EEO Contact:
EEO Officer
(916) 440-7370
civilrights@dhcs.ca.gov
California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

TELEWORK INFORMATION

This position is currently eligible for telework up to three days per week and is required to report in person a minimum of two days per week. The amount of telework is at the discretion of the Department and is subject to change consistent with DHCS’ Telework Program and Government Code sections 14200 – 14203. Telework is available to California residents, and proof of residency may be required.

 

Business travel may be required, and reimbursement considers an employee’s designated office and residence subject to regulations and bargaining unit contract provisions. All commute expenses to the reporting location will be the responsibility of the selected candidate.

 

Personal Leave Program (PLP) 2025 agreement

Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. Please reach out to the hiring unit contact listed on this job advertisement for details.

The DHCS office location for this position is: 830 Stillwater Rd, West Sacramento, CA 95605

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.

Application Methods:
Electronic (Using your CalCareer Account)
By Mail
Drop-off
Print Job