Quality Assurance Nursing Consultant

<div> <h1><span>AHCCCS</span></h1> <h2><span><em><span>Arizona Health Care Cost Containment System<br/>Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork<br/><br/>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.<br/><br/>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. <br/><br/>Come join our dynamic and dedicated team.</span></em></span></h2> </div> <h3 dir="ltr"><span><strong>Quality Assurance Nursing Consultant</strong></span></h3> <h3 dir="ltr"><span><strong>Division of Fee for Service Management (DFSM)</strong></span></h3> <div> <span>Job Location:</span> </div> <div> <h4><span><span>Phoenix - 150 North 18th Avenue Phoenix, Arizona 85007<br/>Tucson - 7202 East Rosewood Street, Suite 125 Tucson, Arizona 85710</span></span></h4> </div> <div> <span>Posting Details:</span> </div> <div> <h4><span><span>Starting salary at $71,032 and may be increased based on experience and qualifications.<br/></span></span></h4> <h4><span><span>FLSA Status: Exempt</span></span></h4> <h4><span><span>Grade: 22<br/></span></span></h4> <h4><span><span>Closing Date: Open until filled</span></span></h4> </div> <div> <span>Job Summary:</span> </div> <div> <p><span>This position will work independently applying clinical knowledge, judgment, and expertise to assess, coordinate, and monitor service delivery. This position will complete comprehensive assessments of available resources on service providers and individual members; review case material to ensure compliance with State and Federal regulations and policies; and provide timely resolution of multiple cases assigned. This position will also be responsible for identifying systemic issues for AHCCCS to address.<br/><br/>This position will be hybrid with some in-office meetings, on-site investigations at least 20% of your time, and reviews as needed. Occasionally, this position may also participate as needed in urgent on-site investigations and reviews outside of normal business hours and weekends.<br/></span></p> <p><em><span>The State of Arizona 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 able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.</span></em></p> </div> <div> </div> <div> <p><span><strong>Major duties and responsibilities include but are not limited to:</strong><br/>• Monitor compliance with State and Federal regulations pertaining to quality management processes, tracking, and trending quality of care concerns and/or health and safety/immediate jeopardy concerns. Receive, research, document, and resolve quality of care and/or health and safety issues utilizing standardized processes. Track, trend, and monitor the status of cases to ensure accurate and timely completion and appropriate referrals using a centralized case management tracking database. Ensure research and resolution of issues or concerns promptly as assigned and identify systemic issues for AHCCCS to address.<br/>• Contributes clinical knowledge to assist in the resolution of quality of care concerns, clinical reviews and Operational Reviews. Completes an independent review of data management and other deliverables, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, action plans, provider education, and related actions as appropriate.<br/>• Conduct on-site investigations regarding possible health and safety concerns, immediate jeopardy situations, and other situations supporting AHCCCS initiatives and ventures. On-site visits may also occur outside of normal business hours and weekends for immediate and urgent situations.<br/>• Ensure quality of care to AHCCCS members, including ensuring member dignity and respect, focused on their unique special health care needs, timely correspondence, and resolution of the quality of care c