What are the responsibilities and job description for the QA Nurse position at Texas Health and Human Services?
Date: Sep 10, 2026
Location:
ALICE, TX
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: QA NurseJob Title: Nurse IIIAgency: Health & Human Services CommDepartment: UR LTSS FTE Random Mmt StudyPosting Number: 21159Closing Date: 10/10/2026Posting Audience: Internal and ExternalOccupational Category: Healthcare Practitioners and TechnicalSalary Range: $5,425.33 - $8,886.16Pay Frequency: Monthly
Salary Group: TEXAS-B-24Shift: Day
Additional Shift
Telework: Eligible for TeleworkTravel: Up to 10%Regular/Temporary: RegularFull Time/Part Time: Full timeFLSA Exempt/Non-Exempt: Exempt
Facility Location:
Job Location City: ALICE
Job Location Address: 408 N FLOURNOY RD
Other Locations: Abilene; Alamo; Alice; Alpine; Alvin; Amarillo; Anahuac; Andrews; Angleton; Anson; Aransas Pass; Archer City; Arlington; Athens; Atlanta; Austin; Bacliff; Ballinger; Bandera; Bastrop; Bay City; Baytown; Beaumont; Bedford; Beeville; Bellville; Big Spring; Boerne; Bonham; Borger; Bowie; Brady; Breckenridge; Brenham; Brownfield; Brownsville; Brownwood; Bryan; Burnet; Caldwell; Cameron; Canton; Canutillo; Carlsbad; Carrizo Springs; Carrollton; Carthage; Center; Centerville; Childress; Clarksville; Cleburne; Cleveland; Coldspring; Columbus; Conroe; Copperas Cove; Corpus Christi; Corsicana; Crockett; Crosby; Crystal City; Cuero; Cypress; Daingerfield; Dallas; Decatur; Del Rio; Denton; Dickinson; Dumas; Duncanville; Eagle Pass; Eastland; Edinburg; El Paso; Elgin; Elsa; Ennis; Fabens; Falfurrias; Floresville; Fort Stockton; Fort Worth; Fredericksburg; Gainesville; Galveston; Garland; Gatesville; Georgetown; Giddings; Gilmer; Goliad; Gonzales; Graham; Granbury; Grand Prairie; Grapevine; Greenville; Hallettsville; Hamilton; Harlingen; Haskell; Hearne; Hemphill; Hempstead; Henderson; Hereford; Hillsboro; Hondo; Houston; Humble; Huntsville; Hurst; Irving; Jacksonville; Jasper; Johnson City; Jourdanton; Karnes City; Katy; Kaufman; Kerrville; Killeen; Kingsville; Kingwood; Kirbyville; La Grange; Lake Jackson; Lake Worth; Lamesa; Lampasas; Lancaster; Laredo; Levelland; Lewisville; Liberty; Linden; Littlefield; Livingston; Llano; Lockhart; Longview; Lubbock; Lufkin; Lumberton; Madisonville; Marble Falls; Marfa; Marlin; Marshall; Mcallen; Mckinney; Mercedes; Meridian; Mesquite; Mexia; Midland; Mineola; Mineral Wells; Mission; Monahans; Mount Pleasant; Mount Vernon; Nacogdoches; Navasota; New Boston; New Braunfels; Odessa; Orange; Palestine; Pampa; Paris; Pasadena; Pearland; Pearsall; Pecos; Perryton; Pharr; Pittsburg; Plainview; Plano; Pollok; Port Arthur; Port Lavaca; Presidio; Quitman; Raymondville; Refugio; Richardson; Richmond; Rio Grande City; Robstown; Rockwall; Rosenberg; Round Rock; Rowlett; Rusk; San Angelo; San Antonio; San Benito; San Juan; San Marcos; San Saba; Schertz; Seguin; Seminole; Seymour; Sherman; Silsbee; Sinton; Snyder; Socorro; Sonora; South Houston; Stephenville; Sugar Land; Sulphur Springs; Sweetwater; Taylor; Temple; Terrell; Texarkana; Texas City; The Woodlands; Tomball; Trinity; Tyler; Uvalde; Van Horn; Vernon; Victoria; Waco; Washington; Watauga; Waxahachie; Weatherford; Webster; Weslaco; Wharton; Wichita Falls; Woodville; Zapata
MOS Codes: 290X,46AX,46FX,46NX,46PX,46SX,46YX,66B,66C,66E,66F,66G,66H,66N,66P,66R,66S,66T,66W
Job Description
Under the general supervision of the UR Nurse Manager, the QA Nurse is responsible for quality assurance activities including but not limited to routine case reading functions and analysis to assess the accuracy of the MCO performance outcomes from the Acute Care Utilization Reviews. This involves examining and reviewing UR outcomes to determine compliance with program regulations, internal policies and procedures, state and federal statutes, identifying inaccuracies, and correcting such inaccuracies. Work involves assisting with planning, developing, and implementing corrective action measures and providing consultative services and technical assistance to program staff.
If you are looking for an opportunity to use both considerable clinical experience and highly developed research and critical thinking skills, this job may be perfect for you.
Essential Job Functions
All essential job functions ensure compliance and knowledge of Texas Medicaid MCOs utilization management with HHSC contracts and state and federal regulations related to STAR Kids, STAR, STAR PLUS, and STAR Health programs:
Conducts case reading functions to ensure consistent execution of business processes and identify areas in need of change and analysis to assess the accuracy of data gathered by acute care clinical staff. Reviews MCO policies and procedures, nursing activities, medical records, and evaluation of medical necessity, to determine compliance with state and federal laws, regulations, and rules related to the program, standards of care, and quality of service. 60%
Collaborates with staff to correct data with errors and provides feedback to the UR Nurse Manager and ACUR leadership pertaining to staff competencies in utilization of review tools and application of ACUR policies and procedures and makes recommendations for process improvements. 20%
Works with the UR Nurse Manager and ACUR leadership to develop and implement UR quality review activities, including ensuring inter-rater reliability and revisions to program protocols, policies, and tools. 20%
Registrations, Licensure Requirements Or Certifications
Must possess a current, unencumbered Texas Registered Nurse license (or a state that recognizes reciprocity through the Nurse Licensure Compact).
Knowledge Skills Abilities
Knowledge of Texas Medicaid policy related to clinical services as detailed in the Texas Medicaid Provider Procedures Manual (TMPPM). Experience with utilization review in authorization of clinical services; case management; managed care utilization review principles and practices. Knowledge of Health and Human Service Commission programs including Medicaid/CHIP. Excellent computer skills, including Microsoft Office Suite. Ability to present orally and in writing to a professional group. 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. Highly proficient in the English language with excellent written, verbal, and interpersonal communication and presentation skills. Ability to actively participate in meetings and workgroups. Skilled in establishing and maintaining effective working relationships with managers, coworkers, and other staff or program stakeholders. Knowledge of quality assurance and improvement measures and principles. Familiarity with ICD-10 and HCPC/CPT codes.
Initial Screening Criteria
Bachelor's degree in nursing preferred.
Minimum three years nursing experience in a clinical setting required.
Experience with at least one of the following: Texas Medicaid, managed care, utilization review experience in authorization of clinical services, or case management.
Additional Information
Information on application must clearly state how applicant meets the initial selection criteria in the Summary of Experience section of the application. Part-time telework opportunities available following successful completion of initial orientation period or in accordance to business needs.
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.
Location:
ALICE, TX
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: QA NurseJob Title: Nurse IIIAgency: Health & Human Services CommDepartment: UR LTSS FTE Random Mmt StudyPosting Number: 21159Closing Date: 10/10/2026Posting Audience: Internal and ExternalOccupational Category: Healthcare Practitioners and TechnicalSalary Range: $5,425.33 - $8,886.16Pay Frequency: Monthly
Salary Group: TEXAS-B-24Shift: Day
Additional Shift
Telework: Eligible for TeleworkTravel: Up to 10%Regular/Temporary: RegularFull Time/Part Time: Full timeFLSA Exempt/Non-Exempt: Exempt
Facility Location:
Job Location City: ALICE
Job Location Address: 408 N FLOURNOY RD
Other Locations: Abilene; Alamo; Alice; Alpine; Alvin; Amarillo; Anahuac; Andrews; Angleton; Anson; Aransas Pass; Archer City; Arlington; Athens; Atlanta; Austin; Bacliff; Ballinger; Bandera; Bastrop; Bay City; Baytown; Beaumont; Bedford; Beeville; Bellville; Big Spring; Boerne; Bonham; Borger; Bowie; Brady; Breckenridge; Brenham; Brownfield; Brownsville; Brownwood; Bryan; Burnet; Caldwell; Cameron; Canton; Canutillo; Carlsbad; Carrizo Springs; Carrollton; Carthage; Center; Centerville; Childress; Clarksville; Cleburne; Cleveland; Coldspring; Columbus; Conroe; Copperas Cove; Corpus Christi; Corsicana; Crockett; Crosby; Crystal City; Cuero; Cypress; Daingerfield; Dallas; Decatur; Del Rio; Denton; Dickinson; Dumas; Duncanville; Eagle Pass; Eastland; Edinburg; El Paso; Elgin; Elsa; Ennis; Fabens; Falfurrias; Floresville; Fort Stockton; Fort Worth; Fredericksburg; Gainesville; Galveston; Garland; Gatesville; Georgetown; Giddings; Gilmer; Goliad; Gonzales; Graham; Granbury; Grand Prairie; Grapevine; Greenville; Hallettsville; Hamilton; Harlingen; Haskell; Hearne; Hemphill; Hempstead; Henderson; Hereford; Hillsboro; Hondo; Houston; Humble; Huntsville; Hurst; Irving; Jacksonville; Jasper; Johnson City; Jourdanton; Karnes City; Katy; Kaufman; Kerrville; Killeen; Kingsville; Kingwood; Kirbyville; La Grange; Lake Jackson; Lake Worth; Lamesa; Lampasas; Lancaster; Laredo; Levelland; Lewisville; Liberty; Linden; Littlefield; Livingston; Llano; Lockhart; Longview; Lubbock; Lufkin; Lumberton; Madisonville; Marble Falls; Marfa; Marlin; Marshall; Mcallen; Mckinney; Mercedes; Meridian; Mesquite; Mexia; Midland; Mineola; Mineral Wells; Mission; Monahans; Mount Pleasant; Mount Vernon; Nacogdoches; Navasota; New Boston; New Braunfels; Odessa; Orange; Palestine; Pampa; Paris; Pasadena; Pearland; Pearsall; Pecos; Perryton; Pharr; Pittsburg; Plainview; Plano; Pollok; Port Arthur; Port Lavaca; Presidio; Quitman; Raymondville; Refugio; Richardson; Richmond; Rio Grande City; Robstown; Rockwall; Rosenberg; Round Rock; Rowlett; Rusk; San Angelo; San Antonio; San Benito; San Juan; San Marcos; San Saba; Schertz; Seguin; Seminole; Seymour; Sherman; Silsbee; Sinton; Snyder; Socorro; Sonora; South Houston; Stephenville; Sugar Land; Sulphur Springs; Sweetwater; Taylor; Temple; Terrell; Texarkana; Texas City; The Woodlands; Tomball; Trinity; Tyler; Uvalde; Van Horn; Vernon; Victoria; Waco; Washington; Watauga; Waxahachie; Weatherford; Webster; Weslaco; Wharton; Wichita Falls; Woodville; Zapata
MOS Codes: 290X,46AX,46FX,46NX,46PX,46SX,46YX,66B,66C,66E,66F,66G,66H,66N,66P,66R,66S,66T,66W
Job Description
Under the general supervision of the UR Nurse Manager, the QA Nurse is responsible for quality assurance activities including but not limited to routine case reading functions and analysis to assess the accuracy of the MCO performance outcomes from the Acute Care Utilization Reviews. This involves examining and reviewing UR outcomes to determine compliance with program regulations, internal policies and procedures, state and federal statutes, identifying inaccuracies, and correcting such inaccuracies. Work involves assisting with planning, developing, and implementing corrective action measures and providing consultative services and technical assistance to program staff.
If you are looking for an opportunity to use both considerable clinical experience and highly developed research and critical thinking skills, this job may be perfect for you.
Essential Job Functions
All essential job functions ensure compliance and knowledge of Texas Medicaid MCOs utilization management with HHSC contracts and state and federal regulations related to STAR Kids, STAR, STAR PLUS, and STAR Health programs:
Conducts case reading functions to ensure consistent execution of business processes and identify areas in need of change and analysis to assess the accuracy of data gathered by acute care clinical staff. Reviews MCO policies and procedures, nursing activities, medical records, and evaluation of medical necessity, to determine compliance with state and federal laws, regulations, and rules related to the program, standards of care, and quality of service. 60%
Collaborates with staff to correct data with errors and provides feedback to the UR Nurse Manager and ACUR leadership pertaining to staff competencies in utilization of review tools and application of ACUR policies and procedures and makes recommendations for process improvements. 20%
Works with the UR Nurse Manager and ACUR leadership to develop and implement UR quality review activities, including ensuring inter-rater reliability and revisions to program protocols, policies, and tools. 20%
Registrations, Licensure Requirements Or Certifications
Must possess a current, unencumbered Texas Registered Nurse license (or a state that recognizes reciprocity through the Nurse Licensure Compact).
Knowledge Skills Abilities
Knowledge of Texas Medicaid policy related to clinical services as detailed in the Texas Medicaid Provider Procedures Manual (TMPPM). Experience with utilization review in authorization of clinical services; case management; managed care utilization review principles and practices. Knowledge of Health and Human Service Commission programs including Medicaid/CHIP. Excellent computer skills, including Microsoft Office Suite. Ability to present orally and in writing to a professional group. 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. Highly proficient in the English language with excellent written, verbal, and interpersonal communication and presentation skills. Ability to actively participate in meetings and workgroups. Skilled in establishing and maintaining effective working relationships with managers, coworkers, and other staff or program stakeholders. Knowledge of quality assurance and improvement measures and principles. Familiarity with ICD-10 and HCPC/CPT codes.
Initial Screening Criteria
Bachelor's degree in nursing preferred.
Minimum three years nursing experience in a clinical setting required.
Experience with at least one of the following: Texas Medicaid, managed care, utilization review experience in authorization of clinical services, or case management.
Additional Information
Information on application must clearly state how applicant meets the initial selection criteria in the Summary of Experience section of the application. Part-time telework opportunities available following successful completion of initial orientation period or in accordance to business needs.
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.
Salary : $5,425 - $8,886