Title: Behavioral Health Prior Authorization/Utilization Review Nurse
Behavioral Health Prior Authorization/Utilization Review Nurse
- REMOTE OPTIONS
Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.
AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.
Come join our dynamic and dedicated team.
Behavioral Health Prior Authorization/Utilization Review Nurse
Division of Fee for Services Management
Address: 801 E. Jefferson Street, Phoenix, AZ 85034
Open until filled
Salary: $60,000 To $71,032
Must reside in the State of Arizona
This position is eligible for full-time remote work (including virtual office arrangement)
The Division of Fee for Service Management is looking for a highly motivated individual to join our team as a Behavioral Health PA/UR Nurse. This position will provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for FFS members’ physical/acute care services and behavioral health needs. Monitor over and underutilization, conduct reviews, provide oversight and technical assistance, gather, plan, organize and evaluate information from multiple sources, including utilization data, case file reviews and audits. Coordinate care with external and internal stakeholders as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a resource for medically necessary covered services. This position has the potential to work from a Virtual Office (VO) setting or may telecommute based on the needs of the unit and at the discretion of leadership.
Major duties and responsibilities include but are not limited to:
- Review clinical documentation to monitor, evaluate and authorize healthcare services. Review for medical necessity, appropriateness of services, quality of care, and compliance with contractual State and Federal obligations governing the provision of covered behavioral and physical healthcare services.
- Obtain, review, analyze, and discuss report and data findings to identify, monitor, and evaluate specialized intervention strategies and outcomes for member populations, including Serious Mental Illness (SMI), and Tribal Regional Behavioral Health Authority (TRBHA).
- Collaborate with AHCCCS providers including SMI clinic, TRBHA, Medical Home or other treatment team members in order to provide technical assistance, training, and consultation on As needed, provides backup for the responsibilities held by the BH Prior Authorization/Utilization Review unit and other Care Management Systems Unit (CMSU) functions as needed.
- Coordinate with internal and external customers as needed, make referrals as necessary, participate in clinical staffing as needed, serve as an FFS health plan subject matter expert.
- Assist in the development of policies and procedures as required for delivery of covered behavioral health services.
- Other duties as assigned as related to the position (typically 5% - 10%).
- Knowledge of Service Authorization concepts, principles, and strategies.
- General knowledge of behavioral health service delivery system and the needs of people diagnosed as having a serious mental illness in receiving behavioral health services for Title XIX, non-Title XIX, and SNP (Special Needs Plan) dual eligible Title XIX adults.
- Knowledge of Principles of behavioral health and medical nursing management and assessment.
- Knowledge of HCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelines.
- Excellent verbal/written communication skills, with FFS Providers.
- Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations.
- Strong interpersonal skills in working with people of diverse cultures and socio-economic backgrounds.
- Strong ability to collaborate with others for mutually beneficial outcome.
- Ability to interpret clinical information and assess implications for treatment.
- Ability to read, interpret, and apply complex rules and regulations.
- Possession of a current license to practice as a registered nurse in the State of Arizona and three (3) year of relevant experience.
- Professional experience in the Healthcare Industry "Specifically experience in Prior Authorization, Concurrent Review, Retrospective Review, and Utilization Management.
* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
* Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension, or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed
Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities
* Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Lifetime Pension Benefit Program
* Administered through the Arizona State Retirement System (ASRS)
* Defined benefit plan that provides for life-long income upon retirement.
* Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
* Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
* Voluntary participation.
* Program administered through Nationwide.
* Tax-deferred retirement investments through payroll deductions.
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing firstname.lastname@example.org.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.