CONCURRENT REVIEW NURSE

State of Arizona - Phoenix, AZ (23 days ago)3.6

Full-time

Arizona Department of Child Safety

A New Beginning for Arizona’s Children

CONCURRENT REVIEW NURSE

Comprehensive Medical and Dental Program
3003 N Central Avenue

Phoenix, AZ 85012

www.dcs.az.gov

JOB SUMMARY:
This position is responsible for the delivery of clinical healthcare services for one of the following comprehensive clinical programs: Quality Management and Performance Improvement (QM/PI), Medical Management (MM), Behavioral Health (BH), Maternity and Family Planning (Mat and FP), Children's Rehabilitative Services (CRS) and Early Periodic Screening Diagnostic and Treatment (EPSDT). This position develops policies and procedures to ensure compliance with federal and state laws, and AHCCCS policies and rules. This position provides technical assistance to CMDP managers, administrative and clinical staff.

JOB DUTIES:
  • Performs health care utilization management, prior authorization, concurrent hospital review, medication authorizations and care coordination (specialized course of treatment or regular care monitoring) for children with CRS qualifying chronic health/medical conditions in foster care throughout the state of Arizona; participates with MSIC (Multi-Specialty Interdisciplinary Clinics) staff, case managers, behavioral health systems, DCS Specialists, early intervention, and Medicaid in the service coordination of high risk/highly complex cases.
  • Administers statewide AHCCCS mandated programs (QM/PI, MM, CRS, Mat and FP, or EPSDT) which includes policy development, reporting, auditing, correspondence, training and program compliance.
  • Represents CMDP CRS in external meetings (such as CFTs with RBHAs, multi-disciplinary staffing’s with MSICs (Multi-Specialty Interdisciplinary Clinics) and other activities with DCS Specialists, caregivers, AHCCCS, health home/medical home (PCPs, pediatricians), and other CMDP Unit Managers. Interprets and applies statutes, regulations, and AHCCCS policy and rules related to CRS; develops reports, Notices of Actions (NOAs), policies, correspondence and other written materials of a complex and professional nature.
  • Participates and maintains availability telephonically for periods beyond regular work hours on a rotational basis; handle incoming telephonic inquiries from pharmacies, members, providers, caregivers and DCS staff during off hours. Respond to prior authorization requests and immediate jeopardy.
  • Participates on teams to identify and address systemic issues using the DCS Management System; participates with policy/procedure development and technical assistance tools.
  • Provides technical assistance to CMDP Assistant Director, Medical Directors, Unit Managers, and staff; responsible for staff development for non-clinical medical services staff.
  • Other duties assigned as related to the position.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
Knowledge of:
  • Health care administration for children with CRS qualifying chronic health/medical conditions in foster care
  • Clinical standards and quality of care for children with CRS qualifying chronic health/medical conditions
  • CRS service plans and qualifying diagnosis
  • Durable medical equipment , orthotics, metabolic formula/foods, MSIC (Children's Clinics) ancillary services
  • Connectivity to community based support services, i.e. education, social services, and family advocacy/leadership development.
  • Microsoft applications
Skill in:
  • Verbal and written communication
  • Establishing and maintaining interpersonal relationships
  • Problem solving
  • Clinical management and leadership practices
  • Mentoring and coaching
Ability to:
  • Acquire knowledge of DCS policies, procedures, and current State, Federal and local laws governing AHCCCS/Medicaid health plan operations and requirements
  • Plan, organize and administer clinical care coordination for children with CRS qualifying chronic health/medical conditions in foster care; navigate the Arizona’s systems of care; the foster care system and related agencies
  • Maintain up-to-date knowledge of agency and department policies and procedures
  • Understand importance of and respect for the confidentiality of member information in accordance with applicable standards and regulations.
  • Clearly identify problems, analyze situations, and rectify quality of care concerns
  • Work under pressure in a high pace environment
SPECIAL SELECTION FACTOR(S):
Current, active AZ RN license; in good standing with AZ Nursing Board.

Requires the possession of, and ability to retain a current, valid state-issued driver’s license appropriate to the assignment. Employees who drive on state business are subject to driver’s license record checks, must maintain acceptable driving records and must complete any required driver training (see Arizona Administrative Code R2-10-207.12).

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.

Must be able to secure and maintain an Arizona Fingerprint Clearance card.

Must be able to secure and maintain clearance from the CPS Central Registry.

PREFERRED QUALIFICATION(S):
Certified professional with experience in pediatric healthcare; public administration etc.; familiarity of Arizona’s healthcare programs, including Arizona Early Intervention Program (AzEIP), Children’s Rehabilitation Services Program (CRS), Arizona’s Regional Behavioral health Authorities (RBHA), AHCCCS and other state and local resources.

PRE-EMPLOYMENT REQUIREMENTS:
Employment is contingent on the selected applicant passing a background investigation.

BENEFITS:
We offer a comprehensive benefits package that includes:
  • Sick leave
  • Vacation with 10 paid holidays per year
  • Health and dental insurance
  • Retirement plan
  • Life insurance and long-term disability insurance
  • Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance
RETIREMENT:
Positions in this classification participate in the Arizona State Retirement System (ASRS).

Enrollment eligibility will become effective after 27 weeks of employment.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-255-2903. Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.