Title: Public Health Nursing Consultant - Case Management

Job Summary :

This position will work independently applying clinical knowledge, judgment, and expertise to assess, coordinate, and monitor service delivery. This position will complete comprehensive assessments of available resources on service providers and individual members; review case material to ensure compliance with State and Federal 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.

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 State’s 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.

Job Duties :

Major duties and responsibilities include but are not limited to :

• Monitor compliance with State and Federal regulations, tracking, and trending case management data to include escalation of and action taken by case management team in response to COOP initiation, quality of care concerns and / or health and safety / immediate jeopardy concerns. Receive, research, document, and resolve quality of care and / or health and safety issues utilizing standardized processes. Track, trend, and monitor the status of cases to ensure accurate and timely completion and appropriate referrals using a centralized case management tracking database. Ensure research and resolution of issues or concerns promptly as assigned and identify systemic issues for AHCCCS to address.
• Ensure quality of care to AHCCCS members, including ensuring member dignity and respect, focused on their unique special health care needs, timely correspondence, and resolution of the quality of care concern. Use independent judgment regarding data to research, status level, interventions, and appropriate resolution.
• Contributes clinical knowledge to assist in the resolution of quality of care concerns, clinical reviews and Operational Reviews. Completes an independent review of data 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, action plans, provider education, and related actions as appropriate.
• Provide education and technical assistance to internal and external stakeholders as appropriate, regarding covered services, and contractual 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 of the unit. Lead special projects and reviews to ensure completion within the designated timelines. Provide ongoing updates to Management.
• Develop metrics for population-specific outcome objectives. Tracking, evaluation, analysis, and revision of metrics as needed based on the ongoing analysis of member data.
• Conduct on-site investigations regarding possible health and safety concerns, immediate jeopardy situations, and other situations supporting AHCCCS initiatives and ventures. Occasionally, and may be required outside of normal business hours and weekends.

Knowledge, Skills & Abilities (KSAs) :

Knowledge of :

Skill in :

Ability to :

Selective Preference(s) :

Arizona Drivers License

Minimum Qualification : Possession of a current license to practice as a registered nurse in the State of Arizona and three (3) years of relevant healthcare experience.

Preferred Qualification : At least one year experience working in a managed care environment. Case Management, Quality Management, Utilization Management and / or social work experience. Certified Professional in Healthcare Quality or case management certification.

Pre-Employment Requirements :

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 :  Driver’s License Requirements.

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

Benefits :

Among the many benefits of a career with the State of Arizona, there are :

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.