Job description

Job Description
Quality Management Public Health Nurse
504657
PHOENIX
REMOTE OPTIONS
AHCCCS
Full-time
AHCCCS
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.
Quality Management Public Health Nurse

Job Location:
Address: 801 E Jefferson St, Phoenix, AZ 85034

Posting Details:
Open until filled
This position is eligible for part-time/full-time remote work (including virtual office arrangement). Must reside in the State of Arizona.
Salary: $71,032

Grade: 22

Job Summary:
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Quality Management Public Health Nurse. 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. 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.
• 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.
• Ensure quality of care to AHCCCS members, including ensuring member dignity and respect, focused on their unique special health care needs, timely correspondence with member acknowledging receipt and upon resolution of the issue. Use appropriate judgment regarding data to research, status level, interventions, and appropriate resolution.
• 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 individual and ongoing meetings, including agendas, minutes, and resulting actions and activities.

Knowledge, Skills & Abilities (KSAs):

• 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.
• Techniques to select a particular approach to analyze, develop, or implement a policy.
• Function as a team lead Medicaid Managed Care regulation.
• Strong interpersonal skills in order to effectively relate to AHCCCS members and their families; multi-disciplinary professions; and Contractor representatives.
• Interpretation of rules, laws and agency policy pertaining to the AHCCCS program.
• Ability to 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.
• Ability to develop, implement and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, and Sister Agency Contractors.

Qualifications:
Minimum:

• Possession of a current license to practice as a registered nurse in Arizona. A temporary permit will be accepted for appointment to this class but a license is a prerequisite for permanent status.

In accordance with CFR §432.50 FFP, skilled professional medical personnel must have professional education and training in the field of medical care or appropriate medical practice.

"Professional education and training" means the completion of a 2-year or longer program leading to an academic degree or certification in a medically related profession.

For this position, a licensed Registered Nurse, Physician's Assistant or Nurse's Practitioner is required.

Experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in a field of medical care.

Preferred:

• Certified Professional in Healthcare Quality.
• Proficient in Word, Access, Excel, PowerPoint and Google Suite.
• At least one year experience working in a managed care environment.
• Case Management and/or social work experience; Quality Management experience.

Pre-Employment Requirements:

• 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 agency’s 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.

Benefits:
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 (12 and 13 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

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:
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.

Contact Us:
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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