Public Health Nursing Consultant

at  State of Arizona

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
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.
AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. 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.
Come join our dynamic and dedicated team.

DIVISION OF FEE FOR SERVICE MANAGEMENT (DFSM)

Job Location:
Address: 801 E. Jefferson Street, Phoenix, AZ 85034
This position may offer the ability to work remotely within Arizona based upon the department’s needs and continual meeting of expected performance measures and at the discretion of leadership.
Posting Details:
Salary: $71,032
Grade: 22
Closing Date: Open Until Filled
Job Summary:
The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as an Public Health Nursing Consultant. This position will provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for FFS members’ physical/acute care services and behavioral health needs. Monitor over and under utilization, conduct reviews, provide oversight and technical assistance, gather, plan, organize and evaluate information from multiple sources, including utilization data, case file reviews and audits. Coordinate care with external and internal stakeholders as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a resource for medically necessary covered services.
Job Duties:

KNOWLEDGE OF:

• Service Authorization concepts, principles, and strategies.
• General knowledge of behavioral health service delivery system and the needs of individuals designated as SMI.
• Principles of behavioral health and medical nursing management and assessment.
• Individual service planning process and substance abuse treatment.
• HCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelines.
• Medical technology, computer data retrieval and input, including EHR, HIE, etc.
• Medicaid and Medicare Federal Regulations, State Statute, Rules, and Policies applicable to AHCCCS programs.
• AHCCCS program design and implementation, prior authorization functions and responsibilities, provider network, and funding source.
• Familiarity with American Indian Tribes, programs and policy.

SKILL IN:

• 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.
• Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations.
• Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds.
• Documentation and reporting of data and trends.

• 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, including SMI, and TRBHA.
• Collaborate with AHCCCS providers including SMI clinic, TRBHA, Medical Home or other treatment team members in order to provide technical assistance, training, & consultation on As needed, provides backup for the responsibilities held by the BH Prior Authorization/Utilization Review unit & other CMSU functions as needed.
• Coordinate with internal and external customers as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a FFS health plan subject matter expert.
• Assist in the development of policies and procedures as required for delivery of covered behavioral health services.
  Knowledge, Skills & Abilities (KSAs):