MaineCare Case Mix Nurse

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Department of Health and Human Services (DHHS)

Health Services Consultant

Opening Date : November 20, 2025

Closing Date : December 5, 2025

Job Class Code : 4381

Grade : 07-22 (Nurses)

Salary : $55,702.40 - $75,920.00 per year

Position Number : 02000-2306

Location : Augusta, Waterville, Skowhegan and will travel extensively throughout Eastern Maine, including Ellsworth, Bar Harbor area

Core Responsibilities :

As a Health Services Consultant working in the Case Mix and Classification Unit you will conduct on-site reviews in nursing, residential care, and adult family care home facilities and perform retrospective audits of the Minimum Data Set (MDS) assessments to ensure each facility receives the correct rate of reimbursement. You will also provide training on the completion of the MDS, case mix purpose and documentation requirements for each type of facility.

Minimum Qualifications :

Registered Nurse and three (3) years of progressively responsible experience in the field of nursing and / or in the delivery of health care services.

LICENSING / REGISTRATION / CERTIFICATION REQUIREMENTS :

Licensed as a Registered Professional Nurse in the State of Maine, as issued by the State Board of Nursing.

In order to properly evaluate your experience, you must briefly respond to the following performance areas in your cover letter :

1. Explain your knowledge and experience with long-term care services and facilities.

2. Describe experience with healthcare compliance, including interpreting rules and regulations.

3. Discuss oral and written communication skills, including the ability to lead and facilitate training sessions and meetings with provider staff, administrators and corporate staff.

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Agency information :

The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.

The Office of MaineCare Services (OMS) within DHHS administers and coordinates several major health care financing programs for Maine's citizens including MaineCare and Maine Rx Plus. This position is in the Case Mix and Classification Unit in the Office of Maine Care Services in Augusta and will travel extensively throughout Eastern Maine.

Application Information :

For questions about this position, please contact Sue Pinette, Asst. Director, Division Medicaid / Medicare Services at (207) 287-3933 or by e-mail at Suzanne.Pinette@Maine.gov

To apply, please upload a resume and cover letter addressing the three performance areas in the Minimum Qualifications section on or before the closing date.

Please submit all documents or files in PDF or Word format.

To request a paper application, please contact Mandy.Hernandez@Maine.gov

Benefits of working for the State of Maine :

No matter where you work across Maine state government, you find employees who embody our state motto-"Dirigo" or "I lead"-as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including :

• Work-Life Fit - Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave , and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
• Health Insurance Coverage - The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary. Use this chart to find the premium costsfor you and your family, including the percentage of dependent coverage paid by the State.
• Health Insurance Premium Credit - Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements.
• Dental Insurance - The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan - The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child-including fathers and adoptive parents-receive six weeks of fully paid parental leave . Additional, unpaid leave may also be available, under the Family and Medical Leave Act.

State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.

Note : Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time.

There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role.

As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics.

If you're looking for a great next step, and want to feel good about what you do, we'd love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.

If you are unable to complete the online application, please contact the Human Resources representative listed on the job opening you are interested in applying for. They will work with you for an alternative method of submitting.