Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Utilization Management/Care Management Nurse
Apply by: 03/25/2020
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 Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Nurse in Utilization Management/Care Management. After extensive training, this position has the potential of being worked from home with some in office meetings. Major duties and responsibilities include but are not limited to:
* Review clinical documentation to monitor, evaluate and approve or deny medical and behavioral health services for the AHCCCS FFS populations.
* Performs prospective, concurrent and retrospective reviews for medical necessity, appropriateness of admission, length of stay, level of care, quality of care, coordination of care based on State and Federal regulations and policies.
* Collaborates with providers, Tribal and AHCCCS staff regarding care coordination, utilization review, prior authorization, coverage criteria, policies and procedures, workflow, member needs, and other issues.
* Evaluates, recommends action, negotiates rates, and provides ongoing monitoring for program policy compliance and reporting of data related to specialty services such as Specialty DME, Exception NF Rates, and Over Institutional Cost services.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* A current Arizona RN or LPN license.
* Demonstrated knowledge/experience with current standards of medical/behavioral practice and delivery of acute/non-acute medical/behavioral care.
* Intermediate computer skills to access and input member information.
* Knowledge of health care delivery systems and mechanisms necessary for coordination and delivery of services.
* Professional experience in the healthcare industry, specifically Prior Authorization, Concurrent Review, Retrospective Review, and Utilization Management.
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.