Healthcare Nursing Consultant

2 weeks ago


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

Position Overview:

The Division of Fee For Service Management (DFSM) is seeking a dedicated professional to join our team as a Public Health Nursing Consultant. This role is essential in providing oversight and technical support to ensure adherence to contractual, regulatory, and statutory requirements for FFS members' physical and behavioral health services. Responsibilities include monitoring service utilization, conducting assessments, and collaborating with various stakeholders to coordinate care effectively.

Key Responsibilities:

• Evaluate clinical documentation to assess, monitor, and authorize healthcare services, ensuring medical necessity and compliance with relevant regulations.

• Analyze data and reports to identify intervention strategies and outcomes for specific member populations, including those with Serious Mental Illness (SMI).

• Work collaboratively with AHCCCS providers and treatment teams to offer technical assistance, training, and consultation as needed.

• Serve as a subject matter expert for FFS health plans, coordinating with internal and external partners and making necessary referrals.

• Contribute to the development of policies and procedures related to the delivery of behavioral health services.

Required Knowledge, Skills & Abilities:

• Understanding of service authorization principles and behavioral health service delivery systems.

• Familiarity with nursing management principles and individual service planning processes.

• Proficiency in medical coding and billing guidelines, including HCPCS and ICD classifications.

• Competence in utilizing medical technology and data management systems, including electronic health records.

• Knowledge of Medicaid and Medicare regulations as they pertain to AHCCCS programs.

• Strong analytical and problem-solving skills, with the ability to work effectively with diverse populations.

Qualifications:

• A valid registered nurse license in the State of Arizona.

• A minimum of three years of relevant professional experience in healthcare.

Benefits:

• Generous paid holidays and vacation time.

• Comprehensive insurance plans, including medical, dental, and life insurance.

• Participation in a top-ranked retirement program with lifetime benefits.

• Opportunities for professional development and career advancement.



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