Thank you
Would you like to be part of an amazing team that makes Arizonans thrive? At the Arizona Department of Economic Security (DES) we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals who are committed to service, community, and teamwork. To learn more about DES please visit des.az.gov or click on the link here to view ‘Our DES’ video. Come Join the DES Team!
The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Nurse Manager. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community.
Essential Duties and Responsibilities include but are not limited to:
•Oversight, management, and performance of the utilization management program for the THP and subcontracted health plans, including deliverables and Operational Reviews (OR). Includes support of all health care services, including District Nurses and the Management Team regarding UM principles and oversight. Act as a liaison with other department staff and functions. Monitor UM activities of clinical and non-clinical staff.
•Participate/lead UM/MM related meetings with the Division, health plans, AHCCCS, as appropriate. Prepare and submit UM/MM standards and OR deliverables to Division Leadership and AHCCCS. Prepare/review/interpret statistical and narrative reports on utilization patterns, expenditures, demographics of service delivery and programs. Work in coordination with the CMO data team and other data teams.
•Review and update policy and procedures relating to MM/UM. Periodically assess the review process, criteria, and norms, and recommend any necessary changes. May access and consult with peer clinical reviewers, Medical Directors, and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost-effective care throughout the medical management process. Participates in CES reviews.
•Monitor, oversee, and conduct inpatient, concurrent, retrospective, out-of-network, and appropriateness of treatment and treatment setting review within the scope of licensure, utilizing appropriate clinical policies and guidelines, eligibility benefits, and contracts, as indicated. Participates in NCQA related reporting, such as unplanned transition.
•Monitor with the goal to prevent complications during members' hospital stays. Advocate for quality of care, quality of life, and shorter hospital stays as appropriate. Maintain and review accurate records of members' clinical information and related activity. Hold collaborative weekly discharge planning meetings for health plans and THP. Maintain good community relationships with hospitals, vendors, and providers for DDD members.
•Assists and supports the THP with hospital discharge, durable medical equipment, and other clinical needs. Assists and supports prior authorization needs for members related to durable medical equipment and other clinical needs.
•Follows all members with transplant-related needs and serves as the transplant coordinator.
•Monitor, oversee, and conduct second-level reviews for contract and policy defined services and equipment. Performs and oversees the PASRR process for Division members.
Knowledge In:
•Utilization Management.
•Microsoft Office and Google programs and spreadsheets.
•Admittance, discharge and billing procedures.
•Principles of nursing administration and management.
•Health assessment methods and techniques.
•Federal Regulations related to Medicaid, Medicare, Federal and State laws, agency rules, policies and procedures for medical services in a managed care environment
•Arizona Health Care Cost Containment System (AHCCCS), Department of Health Services, and Centers for Medicare and Medicaid. Clinical knowledge.
Skills In:
•Intermediate-Advanced Google Sheets and Excel Skills including statistical analysis of data.
•Computer skills including electronic medical record, word processing, spreadsheet and database applications.
•Oral and written communication.
•Team work with internal and external stakeholders.
•Critical thinking and constructive problem solving.
•Delivering safe, efficient and therapeutically effective nursing care.
•Evaluate and coordinate patient care and clinical activities.
•Maintain relationships.
•Leadership, management and supervision.
Ability to:
•Work in an intensive, fast-paced environment with minimal supervision.
•Manage a complex array of projects with rapidly shifting priorities and timelines.
•Evaluate and coordinate patient care and clinical activities.
•Plan, organize, & manage time effectively.
•Analyze and create reports/charts regarding UM data from multiple sources.
•Maintain confidentiality. Communicate effectively, work cooperatively with others, and work independently with minimal supervision.
•Establish and maintain working relationships Write reports, policies and procedures.
•Promote a positive working environment.
•Maintain working knowledge of appropriate computer systems.
The ideal candidate for this position will have:
•A Bachelor of Science in Nursing preferred, 3 years clinical or utilization review experience; 1 year of managed care experience or knowledge of the management process. Certified Case Manager or Accredited Care Manager highly desirable.
•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: Driver’s License Requirements. Any employee operating a motor vehicle on State business must possess and retain a current, valid class-appropriate driver's license, complete all required training, and successfully pass all necessary driver's license record checks. The license must be current, unexpired, and neither revoked nor suspended. Employees who drive on state business are subject to Driver's license record checks, must maintain acceptable driving records, and must complete all required driver training. An employee who operated a personally owned vehicle on state business shall maintain the statutorily required liability insurance (see Arizona Administrative Code (A.A.C.) (R2-10-201.11).
•Successfully pass background and reference check; employment is contingent upon completion of the above-mentioned process and the Agency's ability to reasonably accommodate any restrictions.
•Employee shall have a valid Level One fingerprint clearance card issued pursuant to Arizona Revised Statutes 41-1968 in order to work with children and vulnerable adults.
•Candidates for this position shall be subject to a search of both the Department of Child Safety Central Registry pursuant to A.R.S. 8-804 and the Adult Protective Services Registry pursuant to A.R.S. 46-459.
•All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
•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: Driver’s License Requirements.
The Arizona Department of Economic Security offers a comprehensive benefits package to include:
• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Vacation time accrued at 4.00 hours bi-weekly for the first 3 years
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Sick time accrued at 3.70 hours bi-weekly
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities
• Flexible schedules to create a work/life balance.
Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page
State employees are required to participate in the Arizona State Retirement System (ASRS), the State sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.
On, or shortly after, your first day of work you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines and effective dates.
For questions about this career opportunity, please contact us Alyssa Figueroa at 602-653-9837 or alyssafigueroa@azdes.gov.
The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-653-9837 or alyssafigueroa@azdes.gov. Requests should be made as early as possible to allow time to arrange the accommodation.
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.
The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.
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: Driver’s License Requirements
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