Title: Quality Management Public Health Nurse
Quality Management Public Health Nurse
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. 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. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.
Quality Management Public Health Nurse
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Public Health Nursing Consult. Under the leadership of the Quality Management Manager and Quality Management Supervisor, this position participates in the oversight of quality management structure within the statewide managed care delivery system. Major duties and responsibilities include but are not limited to:
* Monitoring compliance with State and Federal regulations pertaining to quality management, tracking, and trending quality of care complaints. Receive, research, document and resolve quality of care issues utilizing standardized processes and centralized database. Track, trend, and monitor status of cases to ensure accurate and timely completion and appropriate referrals. Ensure research and resolution of quality of care issues.
* The position participates in member grievance process, Operational Reviews, review of quality management plans and other deliverables, 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 dignity and respect, focused on their unique special health care needs, timely correspondence with member acknowledging receipt and upon resolution of the issue. Use appropriate judgment regarding data to research, status level, interventions, and appropriate resolution.
* Provide technical assistance to Contractors, as appropriate, regarding contractual and/or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve quality of care and service to AHCCCS members. Coordinate and complete tracking, evaluation, and responses to Contractor deliverables.
* Participate in special projects and reviews and assure that assigned projects are completed within the designated timelines, with ongoing updates to CQM management. Participate in the development of improved processes and procedures to improve efficiency of the CQM Unit.
* Participate in individual and ongoing meetings, including agendas, minutes, and resulting actions and activities.
* Medical/nursing practice, medical case management protocols, utilization review protocols as related to the acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, and behavioral/mental health.
* Techniques to select a particular approach to analyze, develop, or implement a policy.
* Function as a team lead Medicaid Managed Care regulation.
* Strong interpersonal skills in order to effectively relate to AHCCCS members and their families; multi-disciplinary professions; and Contractor representatives.
* Interpretation of rules, laws and agency policy pertaining to the AHCCCS program.
* 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 within his/her limitations.
* Ability to develop, implement and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, and Sister Agency Contractors.
* Certified Professional in Healthcare Quality.
* Proficient in Word, Access, Excel, PowerPoint and Google Suite.
* At least one year experience working in a managed care environment.
* Case Management and/or social work experience; Quality Management experience.
In accordance with CFR §432.50 FFP, skilled professional medical personnel must have professional education and training in the field of medical care or appropriate medical practice.
"Professional education and training" means the completion of a 2-year or longer program leading to an academic degree or certification in a medically related profession.
For this position, a licensed Registered Nurse, Physician's Assistant or Nurse's Practitioner is required.
Experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in a field of medical care.
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.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
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.