COMPREHENSIVE HEALTH PLAN (CHP)
This nursing position is responsible for the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP) clinical and quality contributions as the subject matter expert for the DCS CHP Quality Department. Responsibilities include leading, evaluating, investigating, monitoring, providing oversight and coordination for behavioral, dental and physical health services for children in foster care throughout the state of Arizona. The role promotes quality and cost effectiveness of healthcare by applying clinical acumen and the appropriate application of State and Federal policies, evidence based criteria and guidelines as well as recognized community standards, as appropriate. This role requires research, data analysis, data interpretation and the utilization of quality tools for contributions for continuous improvement. This role contributes to the development and maintaining of documentation needed for compliance and accreditation(s).
- Contributes to individual and systemic quality of care for the DCS CHP Quality Department. Performs medical necessity reviews, investigations, and follow-up of quality-of care concerns, complaints and grievances. Conducts on-site quality management required visits and/or reviews as needed. Reports, tracks and trends, resolves various measures for quality improvement department wide.
- Reviews, consult and advises on Root Cause Analysis (RCA) and Failure, Mode, Effects and Analysis (FMEA), data gathering and reporting on cases based on set criteria to troubleshoot difficult, complex cases, new technology requests , DCS Management system efforts and other quality strategies for quality improvement with ability to communicate results.
- Communicates with clinical/non-clinical staff, healthcare providers and other healthcare professionals to gather, provide education, report and contribute to continuous improvement as the Quality Department's subject matter expert in areas of Behavioral Healthcare and Physical Healthcare. Manages and responds appropriately to requests in the Quality Inbox. Presents on materials that are quality specific in areas of quality as needed.
- Interprets and applies statutes, regulations, and Arizona Health Care Cost Containment System (AHCCCS) policy and rules; Completes audits, performance review reporting, AHCCCS requests, Healthcare Effectiveness Data and Information Set (HEDIS) reports, accreditation reports and other reports required from the Quality Department or as support to other areas within the DCS CHP.
- Participates and/or available 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.
- DCS policies, procedures, and current State, Federal and local laws governing AHCCCS/Medicaid health plan operations and requirements.
- Knowledge in Behavioral Health Systems tailored to children under the age of 18 years old.
- Healthcare administration as it relates to children in foster care.
- Quality Healthcare practices.
- Quality of Care Concerns (QOC) and Incident, Accident and Death reporting (IAD).
- Clinical standards and quality of care.
- Quality structure, performance improvement, safety and data analysis.
- Healthcare Plan Accreditation.
- Microsoft applications.
- Considerable skill in oral and written communication.
- Considerable skill in clinical problem solving.
- Clinical management and leadership practices.
- Interpersonal, community and group relations.
- Organize and administer health plans.
- Plan, organize and evaluate clinical care coordination within Arizona’s systems of care; the foster care system and related agencies.
- Contribute to 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 problem, analyze situation, and rectify quality of care concerns.
- Work under pressure in a high pace environment.
Experience in pediatric healthcare; managed care with familiarity of Arizona’s healthcare programs, including state and local resources. Health care quality specific experience and health plan experience.
Current, active AZ RN license; in good standing with AZ Nursing Board.
Requires possession of and ability to retain a current, valid state-issued driver's license appropriate to the assignment.
The ability to secure and maintain an Arizona Fingerprint Clearance Card; and the ability to secure and maintain clearance from the DCS Central Registry.
As an employee of the Department of Child Safety you will be entitled to a comprehensive benefits package that can become effective as soon as two weeks after starting!
- Paid sick leave.
- Paid vacation that includes ten (10) holidays per year.
- Competitive health and dental insurance plans.
- Life insurance and long-term disability insurance.
We also offer optional employee benefits that include:
- Vision coverage.
- Short-term disability insurance.
- Deferred compensation plans.
- Supplemental life insurance.
- Employee wellness plans.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
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.
ARIZONA MANAGEMENT SYSTEM (AMS)
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.
State employees are highly engaged, collaborative and embrace a culture of public service.
Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.