Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.
AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens 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 variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.
Come join our dynamic and dedicated team.
Nurse Case Manager
Division of Fee for Service Management
801 E Jefferson St, Phoenix, AZ 85034
Open until filled: 1st review of resumes on 10/07/22
Salary: $60,000 to $71,032.42
This position is eligible for part-time/full-time remote work (including virtual office arrangement). Must reside in the State of Arizona.
The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Nurse Case Manager. 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.
Major duties and responsibilities include but are not limited to:
? Provide care management for clinically complex members in collaboration with internal and external stakeholders as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a FFS health plan subject matter expert.
? 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 AHCCCS requirements and/or expectations to ensure compliance with the contractual, regulatory, & statutory obligations for covered services.
? Assist in the development of policies and procedures as required for delivery of covered behavioral health services.
Knowledge, Skills & Abilities (KSAs):
? Care Management/Case Management concepts, principles, and strategies.
? Interpret clinical information and assess implications for treatment.
? familiarity with American Indian Tribes programs and policy.
? Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds.
? Organizational skills to coordinate, monitor and report on multiple cases simultaneously.
? Documentation and reporting of data and trends.
? Ability to read, interpret, and apply complex rules and regulations.
? Independent decision making yet knowing when to elevate the decision.
? Problem solving identification, evaluation, and imitation of appropriate action, nursing, and case management assessment.
? Possession of a current license to practice as a registered nurse in the State of Arizona and three (3) year of relevant experience.
? Certified Case Manager.
* 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 R2-10-207.12.) 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.
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)
* 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
* Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/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.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
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.
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing firstname.lastname@example.org.
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.