Public Health Nursing Consultant

4 months ago

Phoenix, United States Arizona Official Website of State of Arizona Full time

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:

Major duties and responsibilities include, but are not limited to:
• 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):

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.

Ability to:
• Strong ability to collaborate with others for mutually beneficial outcomes.
• Interpret clinical information and assess implications for treatment.
• Read, interpret, and apply complex rules and regulations.
• Independent decision making yet knowing when to elevate the decision.
• Drive long distances when required.
• Work Virtual Office (VO), Telecommute or both.

Qualifications:

Minimum:
• Possession of a current license to practice as a registered nurse in the State of Arizona.
• Three (3) years of relevant experience.

Preferred:
• Professional experience in the Healthcare Industry; Specifically experience in Prior Authorization, Concurrent Review, Retrospective Review, and Utilization Management.

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 .) 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 (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees).
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Other Leaves - Bereavement, civic duty, and military.
• 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.

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:

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.

  • Public Health Specialist

    2 weeks ago

    Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full time

    Folic Acid Program Outreach InternWe are seeking a talented and motivated intern to join our team at the Arizona Department of Health Services. The ideal candidate will have a strong desire to develop their skills beyond the classroom while contributing to the promotion of public health initiatives.Job Summary:The Folic Acid Program Outreach Intern will work...

  • Adjunct RN Faculty

    3 weeks ago

    Phoenix, United States Grand Canyon Education, Inc. Full time

    What will you create today? At Grand Canyon University our faculty creates tomorrow's educators, nurses, business leaders, musicians and much more through their dedication to our students. The College of Nursing and Health Care Professions provides indirect and direct support in the development and provision of instruction and student evaluation...

  • Healthcare Professional

    6 days ago

    Phoenix, Arizona, United States Maricopa Unified School District #20 Full time

    Job SummaryThe Maricopa Unified School District #20 is seeking a Registered Nurse to join its team. This role will provide health care services to students and staff, conducting physical examinations and sight and hearing screenings.About the RoleThis is an exempt position with a 204-day work calendar. Salary is based on the approved Health Department Salary...

  • Supervisory Nurse

    1 month ago

    Phoenix, United States Indian Health Service Full time

    Locations: Phoenix, AZ Type:Federal Salary Range:Per Year Open Period:10/30/2024 to 11/14/2024 Summary:To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. Experience refers to paid and unpaid experience, including volunteer work done...

  • Women's Health Nurse Practitioner-Sign On Bonus Included 11-8 Shift

    2 days ago

    Phoenix, United States Mountain Park Health Center Full time

    Job DescriptionJob Description As a member of the Mountain Park team, you will have the opportunity to help our community thrive by improving the health of those around you.You’ll work in a supportive environment where your coworkers feel more like family. That’s because the way we connect with each other translates to the care we provide our...

  • Health Benefits | Sr. Consultant

    4 days ago

    Phoenix, United States mosaicpartners Full time

    Top Tier employee benefit, human resources and investment management consulting firm is looking for a Health Benefits | Sr. Consultant to join their growing team. This is an excellent opportunity to work collaboratively with Client Relationship Managers (CRMs) and other health group team members to provide analysis, health and benefit consultative support....

  • Community Health Specialist/RN

    4 weeks ago

    Phoenix, United States Banner Health Full time

    p style="text-align:left">Primary City/State:Phoenix, ArizonaDepartment Name: Poison Center-HospWork Shift: NightJob Category:NursingExplore and excel. At Banner, health care is a team effort. One might be surprised by the number of people who work behind the scenes and play a critical role in ensuring the best care for our patients. Whether it’s a...

  • Advanced Practice Consultant

    4 months ago

    Phoenix, United States Arizona Official Website of State of Arizona Full time

    Job Summary: The Advanced Practice Consultant (APC) investigates both alleged nurse practice and non-nurse practice violations of the Nurse Practice Act, and recommends appropriate disciplinary action to the Board. Job Duties: • Reviews complaints and develops an investigative plan. Interviews complainants, witnesses, providers, and respondents...

  • Senior Government Consultant

    7 days ago

    Phoenix, Arizona, United States Matrix Design Group Full time

    OverviewMatrix Design Group, Inc. is an award-winning, employee-owned engineering, planning, and consulting firm. As an employee-owned company, we are committed to fostering a culture of diversity, respect, and excellence.About the JobWe are seeking a highly motivated Senior Government Consultant to join our team in Colorado Springs, CO; Denver, CO; Phoenix,...

  • Strategic Accounting Manager Consultant

    2 weeks ago

    Phoenix, Arizona, United States Vaco Full time

    Accounting Manager Consultant RoleAs a highly skilled Accounting Manager Consultant, you will provide financial expertise to our clients, handling a variety of general to complex accounting functions. This includes providing analytical support, supervising staff, and assisting in the development of financial statements and reports.Key Responsibilities:Manage...

  • Consultation Liaison Psychiatry Faculty Physician

    12 hours ago

    Phoenix, United States Dignity Health Full time

    OverviewConsultation Liaison PsychiatryDignity Health Medical GroupCommon Spirit Health SystemPhoenix, ArizonaDignity Health Medical Group - Arizona is seeking a Consultation-Liaison Psychiatrist to join our team in Phoenix, AZ.Dignity Health Medical Group works in partnership with St Joseph Hospital Medical Center (SJHMC), the oldest ACS-verified Level I...

  • Biomechanics Nursing Consultant

    2 days ago

    Phoenix, Arizona, United States Exponent Full time

    We are seeking a skilled Biomechanics Nursing Consultant to join our team at Exponent. As a key member of our interdisciplinary team, you will support engineering and scientific consultants in reviewing and summarizing medical records.Key responsibilities include:Reviewing medical record documents with attention to detail to identify key facts and...

  • Pediatric Nurse Practitioner

    1 week ago

    Phoenix, United States Mountain Park Health Center Part time

    Job DescriptionJob DescriptionMUST HAVE 1-YEAR EXPERIENCE AS A PNPProvide high quality medical care to wide variety of patients in a quality oriented, efficient, and cost-effective manner.ESSENTIAL FUNCTIONS AND RESPONSIBILITIESAssumes responsibility for the primary care patient (i.e., health and social histories, physical examinations, handling of acute and...

  • Pediatric Nurse Practitioner- Christown Clinic

    4 weeks ago

    Phoenix, United States Mountain Park Health Center Full time

    Provide high quality medical care to a wide variety of patients in a quality oriented, efficient, and cost-effective manner. Essential Functions:Assumes responsibility for the primary care patient (i.e., health and social histories, physical examinations, handling of acute and chronic illnesses, differential diagnosis, and treatment according to policies and...

  • Registered Nurse RN- Behavioral Health

    1 month ago

    Phoenix, United States Banner Health Full time

    Primary City/State: Sun City West, Arizona Department Name: Psych-4A Geriatric-Hosp Work Shift: Night Job Category: Nursing Banner Health invests in our nurses by training them to confidently and safely deliver excellent patient care. Banner Health is committed to developing the careers of our team members. We care about you, your nursing career...

  • Flex Registered Nurse, Home Health Full Time

    3 weeks ago

    Phoenix, United States Banner Health Full time

    Wound Care-OP-Hosp Work Shift: Nursing 13 / hour, based on education & experience Find your path in health care. Banner Health is committed to not only providing the finest care possible, but to advancing the way care is provided. The largest city in the northeastern part of the state, Sterling is a farm and ranch community with deep roots on the...

  • Registered Nurse RN Home Health

    2 weeks ago

    Phoenix, United States Banner Health Full time

    Primary City/State: Mesa, Arizona Department Name: Banner Staffing Services-AZ Work Shift: Day Job Category: Nursing The future is full of possibilities. At Banner Health, we're excited about what the future holds for home health care. We also understand that in an evolving healthcare landscape that flexibility and compensation are important...

  • LPN Home Health Nurse

    3 weeks ago

    Phoenix, United States Nursing Solutions Full time

    Angels of Care Home Health is looking for Registered Nurses (RN) and Licensed Practical Nurses (LPN) in Phoenix, AZ and surrounding areas. Angels of Care has been caring for the medically fragile community across the nation since 2000! We pride ourselves on our values: Heart, Advocacy, Love, Outreach, and Speed! #HALOS Pay Range: $28 - $42 per hour Angels...

  • Family Nurse Practitioner FNP

    2 months ago

    Phoenix, United States Mountain Park Health Center Full time

    Job DescriptionJob DescriptionPOSITION PURPOSEProvide high quality medical care to wide variety of patients in a quality oriented, efficient, and cost-effective manner.ESSENTIAL FUNCTIONS AND RESPONSIBILITIESAssumes responsibility for the primary care patient (i.e., health and social histories, physical examinations, handling of acute and chronic illnesses,...

  • Pediatric Nurse Practitioner Specialist

    5 days ago

    Phoenix, Arizona, United States Mountain Park Health Center Full time

    As a Pediatric Nurse Practitioner at Mountain Park Health Center, you will play a vital role in delivering high-quality medical care to our patients. We are seeking an experienced and skilled nurse practitioner to join our team.About the RoleThis is a full-time position that requires a minimum of 1 year of experience as a Pediatric Nurse Practitioner. The...