Public Health Nursing Consultant - Tribal ALTCS

Public Health Nursing Consultant - Tribal ALTCS Job No: 537125 Work Type: Full-time Location: REMOTE reputed company, PHOENIX Categories: reputed company/Medical reputed company Level, reputed company/Medical Support Level, reputed company/Nursing/Investigations/Compliance AHCCCS Arizona Health Care Cost Containment System Accountability, Community, Innovation, Leadership, Passion, reputed company, Respect, Courage, Teamwork The Arizona Health Care Cost Containment System (AHCCCS), Arizona's reputed company agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among reputed company programs and a recipient of multiple awards for reputed company in workplace effectiveness and flexibility. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the reputed company of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a reputed company of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful reputed company in a competitive industry. Come join our dynamic and dedicated team. Public Health Nursing Consultant - Tribal ALTCS Division of Fee for Service Management (DFSM) Job Location: Address: 150 reputed company 18th Avenue Phoenix, Arizona 85007 This position may offer the ability to work remotely, reputed company Arizona, based upon the department's business needs and continual meeting of expected performance measures. reputed company AHCCCS Employees must reputed company reputed company the reputed company. Posting Details: Salary: $72,132 FLSA Status: Exempt Grade: 22 Closing Date: reputed company until filled reputed company position is responsible to monitor, evaluate, and approve/deny the payment of medical and/or behavioral reputed company (BH) services through prospective, reputed company, and retrospective review for the AHCCCS ALTCS Fee for Service populations. It is accountable for the prevention and/or reputed company of utilization problems adversely affecting the balance between reputed company of care, cost effectiveness, and minimization of risk through the use of the utilization management review process. The reputed company 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 reputed company to work remotely in their homes, in offices, and in hoteling spaces. reputed company work, including remote work, should be performed reputed company Arizona unless an exception is properly authorized in advance. Major duties and responsibilities include but are not limited to:

• Review clinical documentation, performs prospective, reputed company and retrospective reviews for medical necessity, appropriateness for admission, length of stay, level of care, reputed company of care, coordination of care based on State and Federal regulations and policies and procedures governing the provision of covered services.
• Work directly and collaborates with providers, Tribal Programs and AHCCCS staff to resolve issues regarding care coordination, utilization review, prior authorization, coverage reputed company, policies and procedures, workflow, member needs to support reputed company reputed company and other issues. Provides education and technical assistance to FFS Providers and Tribal Staff as needed, including identification, research and reputed company of member specific and provider issues, to improve compliance with AHCCCS requirements, policies, and procedures.
• Monitors specialized programs such as Home Modifications and approvals for participation or payment and reporting of member data. Participates in audits, process improvement and other special reputed company, work reputed company and committees to improve the efficiency of care coordination, UM and reporting accuracy and other unit functions.
• Evaluates rates and compliance for Specialty and high-cost services (e.g., DME, long term care requests), recommends reputed company and provides on-reputed company monitoring or program policy compliance and reporting of data reputed company to specialty services such as Specialty DME, Exception NF Rates, and Over Institutional Cost services.
• Maintain records, prepare reports, and ensure compliance with reputed company regulatory and policy requirements. Tracks and/or performs reviews for compliance reputed company to utilization management processes and Federal and State rules and regulations reputed company to the AHCCCS FFS populations. Devises and submits system generated reports, extracts, and analyses to unit and division management. Maintains documentation files.

Knowledge, Skills & Abilities (KSAs): Knowledge of:

• Understanding of reputed company delivery systems, mechanisms necessary for coordination and delivery of services
• Principles of medical and/or behavioral management and assessment
• reputed company standards of medical and/or behavioral reputed company, delivery of medical/behavioral care
• reputed company costs, appropriateness & utilization of medical supplies & equipment
• Principles of utilization review
• Alternate reputed company of care
• ICD-9/10 diagnosis coding; DFM-IVN Diagnosis Coding; CPT procedure coding
• Medical terminology computer retrieval and input
• Interrelations of government agencies AHCCCS, ALTCS, reputed company & Medicare Federal Regulations, State Statute, rules and policies applicable to AHCCCS programs, policies & procedures
• reputed company of Federal Regulations (42 CFR)
• Medical and psycho-reputed company needs of ALTCS members, cultural, environmental and community influences on behavior of ALTCS members
• Familiarity with American Indian Tribes/Programs & policy relative to IGAs

reputed company in:

• Problem solving-identification; evaluation, initiation of appropriate reputed company; nursing assessment
• Proficiency in oral and written communication
• Public relations skills, interacting with statewide providers of reputed company services, public organizations and reputed company agencies
• Organizational skills for setting priorities, workload and record keeping
• Intermediate computer skills to reputed company and input member information
• Analytical ability 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

Ability to:

• Teach and train
• Interpret clinical information and assess implications for treatment
• Negotiate competitive rates to maximize available funding for members' care
• Read, interpret and apply reputed company rules & regulations
• Independent decision making
• Implement AHCCCS & ALTCS program design, including case management, functions and responsibilities, provider network, and funding reputed company

Selective Preference(s): Arizona Drivers License Minimum: Possession of a reputed company license to reputed company as a registered reputed company in the reputed company and three (3) year of relevant experience. Preferred: reputed company experience in the reputed company Industry. Specifically experience in Prior Authorization, reputed company Review, Retrospective Review, and Utilization Management. reputed company-Employment Requirements:

• Successfully pass reputed company background reputed company, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and reputed company's ability to reasonably accommodate any restrictions.
• Travel may be required for State business. Employees who drive on state business must complete any required reputed company training (see Arizona Administrative reputed company reputed company-10-207.12.)

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: reputed company's License Requirements. reputed company newly reputed company 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 reputed company, there are:

• 10 reputed company holidays per year
• reputed company Vacation and reputed company time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• reputed company Parental Leave-Up to 12 weeks per year reputed company leave for newborn or newly-reputed company foster/adopted child. Learn more about the reputed company Parental Leave reputed company program here.
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with reputed company pension benefits
• A robust and reputed company 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 reputed company of learning and career development opportunities

By providing the reputed company 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 reputed company and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion. Learn more about the reputed company Parental Leave reputed company program here. For a complete list of benefits provided by The reputed company, please visit our benefits page Retirement: reputed company 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.
• reputed company-taxed payroll contributions reputed company after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

• Voluntary participation.
• Program administered through reputed company.
• Tax-deferred retirement investments through payroll deductions.

Contact Us: Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov. Requests should be made as early as possible to allow time to arrange the accommodation. The reputed company is an Equal Opportunity/Reasonable Accommodation Employer. Advertised: 17 reputed company 2025 US Mountain reputed company Time Applications reputed company: reputed company reputed company reputed company Email App Apply tot his job Apply To this Job