Public Health Nursing Consultant - Phoenix, United States - State of Arizona

State of Arizona

Verified Company

Phoenix, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

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, costeffective 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, entrylevel positions, and internship opportunities,
AHCCCS offers meaningful career opportunities in a competitive industry. _
Come join our dynamic and dedicated team._

Public Health Nursing Consultant

Division of Health Care Services (DHCS)

Job Location:
Address: 801 E. Jefferson Street, Phoenix, AZ 85034

Posting Details:

Salary:
$72,132

Grade: 22

Open Until Filled

Job Summary:

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. Followup 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 onsite visits to conduct QM investigations regarding possible health and safety concerns, immediate jeopardy situations and other situations supporting
AHCCCS initiatives and ventures. Onsite visits may also occur outside of normal business hours and weekends.