Job Description

Public Health Nursing Consultant

  • 523768
  • PHOENIX
  • REMOTE OPTIONS
  • AHCCCS
  • Full-time

AHCCCS

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.

Public Health Nursing Consultant

Division of Fee For Service Management (DFSM)

Job Location:

Address: 801 E. Jefferson Street, Phoenix AZ 85034


This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of the expected performance measures. 

Posting Details:

Salary: $71,032 

Grade: 22

Closing Date: Open Until Filled

Job Summary:

The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as an Public Health Nursing Consultant. This position is responsible for claims review and adjudication in a timely manner to avoid penalties, establishing and maintaining records and reports, interacting with claims personnel for review and assessing adjudication work process, recommending edits and recommending the need for revising claim charges, review of system parameters in accordance with AHCCCS Rules, Regulations and Federal Guidelines. 

Job Duties:

Major duties and responsibilities include but are not limited to:
* Performs medical claims review/adjudication using claims industry standards. Determines if a claim meets emergent criteria, medical necessity, and/or  correct CPT coding. Also determines if the level of care and length of hospital stay was appropriate for the AHCCCS recipient.
*  Prepares reports such as cost savings of denials, as well as, analyzes savings and trends. Interacts with other departments/providers as needed.
*  Reviews and/or defends claims review at grievance hearings as needed.
*  Performs special projects including but not limited to research projects.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
* Medical nursing practice, medical case management protocols, quality management and utilization review protocols as related to all populations including Maternal and Child Health services, preventive health, family planning, sterilization, and pregnancy termination, EPSDT, acute, LTC, chronic long-term elderly and physical disabled, developmentally disabled, behavioral/mental health, and tribal.
* Healthcare delivery system nationally and locally.
* Managed care processes.
* Acute nursing processes including assessment, planning, intervention, and evaluation.
* InterQual Criteria.
* CCI
* Coding: CPT, HCPCS, ICD-9.
* Medical Claims Review.
* Statistical analysis.
* Computer data retrieval and input.
* Interpretation of governmental agencies.
* AHCCCS Rules and Regulations.
* Code of Federal Regulations.

Skill in:
* Organizational skills that result in prioritization of multiple tasks.
* Interpretation of rules, laws and agency policy pertaining to the AHCCCS program.
* Good written and communication skills.
* Computer skills.
* Utilization Review skills.
* Medical Claims Review skills.
* Performing in a productive environment with limited supervision.
* Effectively collaborating with people in positions of all levels.
* Research and analysis.
* Team player and can work independently.

Ability to:
* Interpret and apply medical and claims policies.
* Read and interpret medical documentation.
* Evaluate medical documentation for emergency criteria, medical necessity, correct CPT coding.
* Determine appropriate hospital levels of care and lengths of stay.
* Respond to inquiries and grievances / answer utilization review questions Document rationale for UR/CPT coding decisions.
* Maintain data for monthly reports.
* Work independently with minimal supervision.
* Ability to work in a Virtual Office, Telecommute or both.

Selective Preference(s):

In possession of a current Arizona Drivers License

Minimum:
*  Possession of a current license to practice as a registered nurse in the State of Arizona and three (3) years of relevant experience.

Preferred:
*  Experience in concurrent and retrospective review; CCI, lnterQual, HCPCS and CPT Coding; managed care medical review experience.
*  Certification in CPT Coding is a plus.

Pre-Employment Requirements:

* 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.

Benefits:

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).
* Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
* Other Leaves - Bereavement, civic duty, and military.
* 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.

Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

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.

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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