Title: Public Health Nursing Consultant

• 523488

• PHOENIX
• REMOTE OPTIONS

• AHCCCS

• Full-time

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. This position will be primarily virtual with some in-office meetings and on-site investigations and reviews as needed. This position will also participate as needed in on-site investigations and reviews outside of normal business hours and weekends. The position is responsible for understanding the needs of stakeholders especially those of members with unmet health care needs, members diagnosed with developmental delays, members diagnosed with behavioral health conditions, members with special health care needs and families of children with special health care needs.

This position will work directly with all AHCCCS populations in a managed care structure, including physical health, behavioral health, and LTC Supports and Services. The position ensures acknowledgment of receipt of issues for investigation to members, AHCCCS Administration, the Governor's office, legislators and other advocacy groups to ensure that member issues and concerns have been investigated and resolved. The position is responsible for increasing member satisfaction and improving risk management efforts for AHCCCS by resolution of quality of care complaints in a timely and comprehensive manner. Direct clinical knowledge and expertise is applied by this position in review and timely resolution of the cases assigned and to identify systemic issues for AHCCCS to address. The position may take lead roles in quality management special projects and may take an active part in managed care RFP processes and scoring.

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 in a timely manner as assigned and identify systemic issues for AHCCCS to address.
* 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.
* 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 on-site visits to conduct QM 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.

Knowledge:
* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, and LTC Supports and Services.
* 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.
* Acute and LTC case management development, implementation, and ongoing review.
* Quality management and utilization review processes.
* Managed care processes.
* Techniques to select a particular approach to analyze, develop, or implement a policy.
* Project management methodologies.
* Statistical, data analysis, and research methods.
* In depth knowledge of problem solving and technical writing.
* Function as a team lead Medicaid Managed Care regulations.

Skills:
* Acute nursing processes including assessment, planning, intervention, and evaluation; Nursing assessment skills for elderly and persons with physical, mental, and developmental disabilities.
* Strong interpersonal skills in order to effectively relate to AHCCCS members and their families; multi-disciplinary professions; and Contractor representatives.
* Negotiation skills and resourcefulness as it applies within the state agency, its partnerships, and outside sources.
* Good written and communication skills; Effective communication with all levels of professionals, corporate and agency officers, and members.
* Understanding of and experience with special health care needs populations.
* Effectively lead and/or facilitate a team of professionals from within and/or outside the agency
* Multi-tasking in a fast-paced environment; Producing work products with limited supervision.
* Project management to meet goals and deadlines.
* Interpretation of rules, laws and agency policy pertaining to the AHCCCS program.
* Analysis of problems and develop effective plans for corrective action.
* Establishment and maintenance of effective working relationships.
* Drafting, implementing, and interpreting of agency policy.
* Representing the agency in public forums.
* Providing effective guidance and technical assistance regarding AHCCCS programs.

Abilities:
* 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.
* Develop, implement and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, and Sister Agency Contractors.

Arizona Driver's 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 (1) 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.