Public Health Nursing Consultant - Prior Authorization and Utilization Review

State of Arizona - Phoenix, AZ

Job Title: Public Health Nursing Consultant - Prior Authorization and Utilization Review

Position: Nursing Consultant

Job Type: Full Time

Pay: $71,032

Shift:

Work Type: Remote

Address:

City: Phoenix

State: AZ

ZIP Code:

Collaborates with providers, Tribal and AHCCCS staff regarding care coordination, utilization review, prior authorization, coverage criteria, policies and procedures, workflow, member needs, and other issues.
Evaluates, recommends action, negotiates rates, and provides ongoing monitoring for program policy compliance and reporting of data related to specialty services such as Specialty DME, Exception NF Rates, and Over Institutional Cost services.
Confers with Utilization Review Coordinators from the Peer Review Organization regarding concurrent review of length of stay and appropriateness of services.
Provides education and technical assistance to FFS Providers and Tribal staff as needed, including identification, research and resolution of member specific and provider issues, to improve compliance with AHCCCS requirements, policies, and procedures.
Tracks and/or performs focused reviews for compliance related to utilization management processes and Federal and State Rules and Regulations related to the AHCCCS FFS populations.
Maintains documentation files.
Devises and submits system generated reports, extracts, and analyses for unit and division and management.
Participates in process improvement and other special projects, work groups, and committees to improve the efficiency of care coordination, utilization management, and other functions in the Clinical Administration unit.

Professional experience in Prior Authorization, Concurrent Review, Retrospective Review, and Utilization Management
Tolerance and understanding of diverse cultures and socioeconomic backgrounds

Experience: Three (3) years of relevant experience

Education: Current license to practice as a registered nurse in the State of Arizona

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

10 paid holidays per year
Paid Vacation and Sick time off (13 and 12 days per year respectively)
Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child
Other Leaves - Bereavement, civic duty, and military
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
RideShare and Public Transit Subsidy
A variety of learning and career development opportunities