Title: Case Management Nurse

The Division of Fee For Service Management is looking for a highly motivated individual to join our team as a BH Case Management Nurse. This position will provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for FFS members. Monitor over and under utilization, conduct reviews and audits. Coordinate care with external and internal stakeholders including IHS/638, TRBHA, AIMH, or BH Integrated Clinics as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a resource for medically necessary covered services.

Major duties and responsibilities include but are not limited to:
? Provide care management for clinically complex members in collaboration with internal and external stakeholders as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a FFS health plan subject matter expert.
? 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 in order to identify, monitor, and evaluate specialized intervention strategies and outcomes for member populations TRBHA.
? Collaborate with AHCCCS Providers including TRBHA, Medical Home or other treatment team members in order to provide technical assistance, training, & consultation on AHCCCS requirements and/or expectations to ensure compliance with the contractual, regulatory, & statutory obligations for covered services.
? Assist in the development of policies and procedures as required for delivery of covered behavioral health services.

Knowledge:
? Knowledge of Care Management/Case Management concepts, principles, and strategies.
? General knowledge of behavioral health service delivery system
? Knowledge of Medical and Behavioral healthcare management and delivery.
? Knowledge of HCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelines.

Skills:
? Problem solving identification, evaluation, and imitation of appropriate action, nursing, and case management assessment.
? Excellent verbal/written communication skills, with FFS Providers.
? Organizational skills to coordinate, monitor and report on multiple cases simultaneously.

Abilities:
? Strong ability to collaborate with others for mutually beneficial outcomes.
? Ability to read, interpret, and apply complex rules and regulations.
? Ability to interpret clinical information and assess implications for treatment.

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

Preferred:
? 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 agencys 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 careers@azahcccs.gov.
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.