The Division of Fee for Service Management is looking for a highly motivated individual to join our team as a Behavioral Health Case Management Nurse. This position will lead regular clinical discussions and Indian Health Services (IHS)/638 providers and/or Behavioral Health Contractors/providers regarding high utilization, trends, and complex cases. The position conducts work with tribes to establish rapport and close collaboration. The position participates in overall coordination of care efforts in the Unit.
Major duties and responsibilities include but are not limited to:
● Coordinates medical and behavioral health care specialized transports for members with unusual and complex cases, CRS conditions and other special health care needs, discharge planning and coordination of continued care, i.e., arranging for DME, specialty care, SNF, CRS referrals, or home health.
● Conduct contact work with tribes, TRBHA’s, and HIS/638 medical homes to establish rapport and close collaboration with community providers and facilities. Conduct contact work with other Fee-for-Service providers for care coordination.
● Coordinate services and authorizations for members transitioning from AHCCCS Health Plans to American Indian Health Program. This will include contact work with FFS Providers who serve American Indians to encourage that members be seen in tribal or HIS facilities in their home communities.
• Coordinate medical care for transplants in conjunction with the AHCCCS Division of Healthcare Management, including specialized transportation, meals, and lodging.
• Serve as back up resource to all clinical functions in the Care Management Systems Unit. Participates in process improvement and other special projects, workgroups, and committees to improve the efficiency of care coordination, utilization management and other CMSU, Clinical Operations Unit functions.
• Develop reporting/tracking/trending to present to DFSM management.
● Case Management concepts, principles, and strategies.
● Medical and Behavioral healthcare management and delivery.
● Knowledge of HCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelines.
● Medical technology computer data retrieval and input.
● Familiarity with American Indian Tribes programs and policy.
● Problem solving-identification, evaluation, and initiation of appropriate action, nursing, and case management assessment.
● Excellent verbal/written communication skills.
● Organizational skills to coordinate, monitor and report on multiple cases simultaneously.
● Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations.
● Strong interpersonal skills in working with people of diverse cultures and socio-economic backgrounds.
● Strong ability to collaborate with others for mutually beneficial outcome.
● Interpret clinical information and assess implications for treatment.
● Ability to read, interpret, and apply complex rules and regulations.
● Drive long distances when required.
● Independent decision making yet knowing when to elevate the decision.
● Current Arizona Registered Nurse License.
● Case Management certification or 1 year of direct case management experience. Experience with care management and/or care coordination. Experience with prior authorization and utilization review. Previous experience working with Tribal facilities and/or healthcare delivery system.
• 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.
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 (12 and 13 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 email@example.com.
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.
The State of Arizona is an Equal Employment Opportunity Employer.