QA INVESTIGATIVE NURSE

Job Summary:

Would you like to be part of an amazing team that makes Arizonans thrive? At the Arizona Department of Economic Security (DES) we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals who are committed to service, community, and teamwork. To learn more about DES please visit or click on the link to view ‘Our DES’ video. Come Join the DES Team

The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a QA Investigate Nurse (Performance Improvement Nurse). DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community.

The QA Investigative Nurse (Performance Improvement Nurse) reports to the Quality Management (QM) Manager. This position: assists with data analytics within the Quality Management Unit (QMU); upholds contractual agreements between the Division of Developmental Disabilities (Division/ DDD) and the Arizona Health Care Cost Containment System (AHCCCS) to implement and operate the provisions of the Arizona Long-Term Care System; manages the end-to-end QMU Health Plan (HP) Elevation process, including referral entry, documentation, health plan communications, and AHCCCS Portal communications; communicates with internal DDD customers and external HP agencies to complete the analysis and workflow processes and provides the monthly analysis and summary reports.

This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.

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:

Essential duties and responsibilities include but are not limited to:
• Completes HP Elevation referral entry. Manages HPE documentation in the AHCCCS QM Portal and internal tracker tools. Communicates with DOD Subcontracted HP and AHCCCS for additional fact-finding and resolution of HP Elevations. Reviews the subcontracted HP investigation findings for accuracy and completeness. Provide the QM Manager with monthly analysis and summary reports.
• Reviews daily the submitted IRs for incidents of Member mortalities. Submits a summary and recommendation for a Quality-of-Care Investigation to the QM Medical Director. Manages the Annual Mortality Tracker with details about Member deaths. Coordinates delivery of Death Certificates, Medical Examiner reports, and any additional information, as available, from other governmental entities.
• Collaborates with the QM Manager in determining Member deaths reviewed during the monthly Mortality Review Committee meetings. Prepares meeting agendas, presentations, and handout materials before each committee meeting.
• Analyzing incidents marked as Track and Trend. Creating Pivot Tables and other analytic tools showing areas of interest for further investigation by the QMU Data Team and the QM Manager including outlines, graphs, draft reports, and other modalities.
• Prepares meeting agendas, presentations, and handout materials before each committee meeting. Completes monthly Consent Report for the QM Subcommittee.

Knowledge, Skills & Abilities (KSAs):

Knowledge Of:
• Applicable laws, rules, policies, and procedures about quality assurance
• Time Program guidelines, standards, and practices Arizona Health Care Cost Containment, System (AHCCCS) , Department of Health Services (DHS) , and Centers for Medicare and Medicaid (CMS) rules and regulations.
• Principles of group dynamics, relationships, and human development.
• Nurse Practice Act. Managed care environment.
• Developmental Disabilities and Division philosophy of service provision.
Skills In:
• Technological skills, including the use of databases, Google Workspace products, email, and electronic referral and verification sources.
• Producing professional technical reports, letters, and other items. Analyze problems and develop effective plans for corrective action.
• Strong interpersonal skills to effectively relate to AHCCCS members, their families, and Agency stakeholders.
• Medical chart review. Oral and written communication and research analysis.
• Nursing processes, including assessment, monitoring, and evaluation.
Ability To:
• Interpret rules, laws, and policies and apply to unique case circumstances.
• Organize, prioritize, and track files and information from various sources.
• Work independently and with a variety of internal and external customers.
• Think critically, organize workflow, and modify existing processes with minimal supervision.

Selective Preference(s):

The ideal candidate for this position will have:
The preferred candidate will have experience in clinical informatics and data analytics.

Pre-Employment Requirements:

• Required at time of appointment: possession of a current license to practice as a registered nurse in the State of Arizona.
• Employee shall have a valid Level One fingerprint clearance card issued pursuant to Arizona Revised Statute 41-1968 in order to work with children and vulnerable adults.
• Candidates for this position shall be subject to a search of the Child Protective Services Central Registry pursuant to A.R.S. 8-804.

• 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: 

• Successfully pass background and reference check; employment is contingent upon completion of the above-mentioned process and the Agency’s ability to reasonably accommodate any restrictions.

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

Benefits:

The Arizona Department of Economic Security offers a comprehensive benefits package to include:

• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Vacation time accrued at 4.00 hours bi-weekly for the first 3 years
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Sick time accrued at 3.70 hours bi-weekly
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities
• Flexible schedules to create a work/life balance

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

Retirement:

State employees are required to participate in the Arizona State Retirement System (ASRS), the State sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.

On, or shortly after, your first day of work you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines and effective dates.

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