Nurse Fair Hearings Officer

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:

Nurse Fair Hearings Officer

Job Title:

Hearings Officer V

Agency:
Health & Human Services Comm

Department: AD Fair & Fraud Hearings

Posting Number: 13335

Closing Date: 02/12/2026

Posting Audience:
Internal and External

Occupational Category:
Legal

Salary Group: TEXAS-B-24

Salary Range: $5,425.33 - $7,155.75

Pay Frequency:
Monthly

Shift: Day

Additional

Shift:

Telework:
Eligible for Telework

Travel:
Up to 10%

Regular/Temporary:
Regular

Full Time/Part Time:
Full time

FLSA Exempt/Non-Exempt:
Nonexempt

Facility

Location:

Job Location City: LUBBOCK

Job Location Address: 6302 IOLA AVE

Other Locations:
Lubbock;
Abilene;
Fort Worth;
Houston;
San Antonio

MOS Codes: ,X,270A,27A,27D,51JX,LGL
10,LN,YN,YNS

Brief

Job Description

This position is for a Hearings Officer V in the Fair and Fraud Hearings Department. Fair and Fraud Hearings is one of three departments in the Appeals Division of the Office of Chief Counsel (OCC).

Hearings Officer V

Performs advanced legal and technical work involving administrative hearings for complex Medicaid programs that may involve general counsel, opposing attorneys, disability rights, high dollar amounts, and sensitive cases administered by the Health and Human Services Commission (HHSC) and other state agencies contracting with HHSC. Work involves overseeing and presiding over a high volume of Medicaid fair hearings on matters requiring interpretation and application of a diverse array of state and federal laws and regulations.

Hearings Officers ensure adverse determinations comply with laws and program policies. Hearings Officers must understand the appropriate role and expected conduct of an administrative judge and the duties required to prepare for and conduct a fair hearing. Hearings Officers must effectively communicate with appellants and their representatives as well as state employees, and service providers; arrive at the appropriate facts of a case;

and render an impartial decision.

Leads and guides less tenured Hearings Officers. Performs quality assurance reviews of decisions for other Hearings Officers for compliance with federal and state legislative requirements and appropriate policy interpretation. Identifies training needs and provides training to staff. Manages area staff in the absence of the area manager. Attends monthly management meetings with the Director. Monitors staff by pulling reports in TIERS.

Assists the area Manager with the hiring process. Works under minimal supervision with extensive latitude for the use of initiative and independent judgment.

Essential Job Funtions (EJFs)

Presides over Medicaid fair hearings for more complex, high profile, high dollar durable medical equipment, and sensitive cases for program areas including medical necessity for long term care, community care services, plan issues, nursing facility discharges, home health services, EPSDT services, dental cases, supplies and acute care medical procedures. (40%)

Admits, evaluates and interprets evidence including sworn testimony and appropriately applies law regarding procedural matters raised in hearings. Determines credibility and weighs evidence to determine if the agency has met its burden of proof regarding the medical eligibility of appellants. Responsible for rendering legally sufficient decisions for fair hearings, preparing findings of facts and conclusions of law, considering testimony and evidence, and writing orders establishing clear instructions to the agency.

Requests policy and legal clarifications, if necessary. (40%)

Leads and guides Hearings Officers for compliance with federal and state legislative requirements and appropriate policy interpretation. Conducts quality assurance reviews of Hearings Officers' decisions to ensure compliance. Identifies training needs and provides training to staff and assists with staff development. (10%)

Manages area staff in the absence of the area manager. Attends monthly management meetings with the Director. Monitors staff by pulling reports in TIERS. Assists the area Manager with the hiring process. (5%)

Tracks, monitors, plans, coordinates, and schedules activities on a complex level using TIERS, managing hearings docket to ensure deadlines and requirements are met. (5%)

Knowledge, Skills, and Abilities (KSAs)

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…