Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Public Health Nursing Consultant
First Resume Review: 04/15/2019
This position will remain open until filled.
Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results. State employees are highly engaged, collaborative and embrace a culture of public service. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Public Health Nursing Consultant. The position is responsible for understanding the needs of stakeholders especially those of members with unmet health care needs, members diagnosed with a Serious Mental Illness (SMI) or other behavioral health conditions, members diagnosed with development delays, members with special health care needs, and families of children with special health care needs. This position will work directly with ALTCS, Acute, foster care (CMDP), CRS, DDD, AIHP, and RBHA quality management areas; however, the primary focus will be on cases involving behavioral health conditions. Major duties and responsibilities include but are not limited to:
* Receive, research, document, and resolve quality of care issues utilizing standardized processes and centralized databases. Track, trend, and monitor status of cases to ensure thorough and timely completion as well as appropriate referrals. Primary emphasis will be placed on special populations such as those utilizing behavioral health services. Ensure research and resolution of quality of care issues in a timely manner as assigned and identify systemic issues for AHCCCS to address.
* Participate in operational reviews, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, corrective action plans, notices to cure and sanctions as appropriate.
* Ensure quality of care to AHCCCS members, including ensuring member health and safety as well as dignity and respect. Focus on unique aspects of each case, individual care needs, timely correspondence with members, and timely acknowledgment of concerns as well as resolution of the issue. Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.
* Participate in special projects and reviews as assigned and assure completion within the designated timelines. Provide ongoing updates to leadership.
* Coordinate and complete tracking, evaluation and responses to Contractor deliverables.
* Provide technical assistance to Contractors and FFS providers, as appropriate, regarding contractual and/or policy requirements to improve quality of care and service delivery to AHCCCS members.
* Participate in individual and ongoing meetings, including agendas, attainment of speakers, minutes and resulting actions and activities.
* Participate in the development of improved processes and procedures to improve efficiency of the QM Unit.
* Participate in peer review processes including presentation of challenging and high profile cases, and initiate resolution activities as directed by the AHCCCS Chief Medical Officer.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Demonstrated knowledge of State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, Behavioral Health, LTC and Tribal and Children’s Rehabilitative Services
* Demonstrated knowledge of Medical/nursing practice, medical case management protocols, utilization review protocols as related to assigned populations (e.g. Acute, behavioral health, Long Term Care)
* Knowledge of techniques to select a particular approach to analyze, develop or implement a policy, Project management methodologies and Behavioral Health delivery system.
* Strong interpersonal skills in order to effectively relate to AHCCCS members, their families, and Agency stakeholders.
* Skilled in acute nursing processes including assessment, planning, intervention and evaluation
* Understanding of and experience with special health care needs populations.
* Strong ability to assess members from a holistic perspective with an emphasis on recognizing medical, social, environmental and emotional conditions, barriers for meeting medical needs that interfere with the member's ability to function at an optimal level.
* Certified Professional in Healthcare Quality
* At least one year experience working in a managed care environment
* Case Management and/or social work experience
At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan. Click here to learn more about benefits.
Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.
Click the APPLY NOW button to submit your application.
For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.