Title: Public Health Nursing Consultant

• 524443

• PHOENIX
• REMOTE OPTIONS

• AHCCCS

• Full-time

This position will work independently applying clinical knowledge, judgment, and expertise to complete comprehensive assessments on service providers and individual members, reviewing case material to ensure compliance with regulations and policies and provide timely resolution of multiple cases assigned. This position will also be responsible for identifying systemic issues for AHCCCS to address.

This position will be hybrid with some in-office meetings and on-site investigations and reviews as needed. Occasionally, this position may also participate as needed in urgent on-site investigations and reviews outside of normal business hours and weekends.

Major Duties and responsibilities include, but not limited to:

• Monitor compliance with State and Federal regulations pertaining to quality management processes, tracking, and trending quality of care concerns and/or health and safety/immediate situation concerns. Receive, research, document, and resolve quality of care and/or health and safety issues utilizing standardized processes and a centralized database. Track, trend, and monitor the status of cases to ensure accurate and timely completion and appropriate referrals. Ensure research and resolution of issues or concerns promptly as assigned and identify systemic issues for AHCCCS to address.
• Contributes clinical knowledge 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 members acknowledging receipt, and upon resolution of the issue. Use independent judgment regarding data to research, status level, interventions, and appropriate resolution.
• Provide education and technical assistance to Staff, Providers or 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.
• Develop improved processes and procedures to improve the efficiency. Lead special projects and reviews to ensure completion within the designated timelines. Provide ongoing updates to
  Management.
• Coordinate and complete tracking, evaluation, and responses to Contractor deliverables.
• Conduct on-site investigations regarding possible health and safety concerns, immediate jeopardy situations, and other situations supporting AHCCCS initiatives and ventures. On-site visits may also occur outside of normal business hours and weekends.

These positions may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the States Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Knowledge of or ability to learn:

• State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, and LTC Supports and Services
• Current standards of medical/ behavioral practice and modes of delivery for acute and non-acute medical/behavioral care/services
• Quality management and utilization review regulations, rules and processes
• AHCCCS and Medicaid regulations, policies, and procedures and applicable federal and state statutes, regulations and rules
• 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
• Case management development, implementation, and ongoing review

Skills in:

• Acute nursing and clinical processes including assessment, planning, intervention, and evaluation
• Clinical assessment skill
• Problem solving techniques, evaluation and initiation of appropriate action
• Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic background
• Project management to meet goals and deadlines
• Research and analytical skills
• Intermediate computer skills

Ability to:

• Strong ability to collaborate with others for a mutually beneficial outcome
• Interpret clinical information and assess implications for treatment
• Read, interpret and apply complex rules and regulations
• Independent decision making, yet knowing when to elevate an issue or concern
• Make effective decisions in a high volume, fast paced environment
• Ability to work Telecommute

• Maintaining a current Arizona Drivers License.

Minimum:

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

Preferred:

• At least one year experience working in a managed care environment.
• Case Management, Quality Management, and/or social work experience.
• Certified Professional in Healthcare Quality.

* 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.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Drivers License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

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

By providing the option of a full-time or part-time 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.

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

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. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.