The Division of Fee for Service Management is looking for a highly motivated individual to join our team as a Behavioral Health Prior Authorization/Utilization Nurse. This position will provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for the FFS members’ physical/acute care services and behavioral health needs. Monitor over and underutilization, conduct reviews, provide oversight and technical assistance, gather, plan, organize and evaluate information from multiple sources, including utilization data, case file reviews and audits.
Major duties and responsibilities include but are not limited to:
● Review clinical documentation to monitor, evaluate and authorize healthcare services. Review for medical necessity, appropriateness of services, quality of care, and compliance with contractual State and Federal obligations governing the provision of covered behavioral and physical healthcare services. List duties here
● Obtain, review, analyze, and discuss report and data findings in order to identify, monitor, and evaluate intervention strategies and outcomes. List duties here
● Collaborate with AHCCCS providers,TRBHA, Medical Home or other treatment team members in order to provide technical assistance, training, and consultation on AHCCCS requirements and/or expectations to ensure compliance with the contractual, regulatory, and statutory obligations for covered behavioral health services.
● Coordinate with internal and external customers as needed, make referrals as necessary, participate in clinical staffing's as needed, serve as a FFS health plan subject matter expert.
● Assist in the development of policies and procedures as required for delivery of covered behavioral health services.
Knowledge of Service Authorization concepts, principles, and strategies.
● Knowledge of General knowledge of behavioral health service delivery system and the needs of people diagnosed as having a serious mental illness in receiving behavioral health services for Title XIX, non-Title XIX, and SNP (Special Needs Plan) dual eligible Title XIX adults.
● Knowledge of Principles of behavioral health and medical nursing management and assessment.
● Knowledge of HCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelines.
● Knowledge of American Indian Tribes, programs and policy.
● Medical technology, computer data retrieval and input, including EHR, HIE, etc.
● Excellent verbal/written communication skills, with FFS Providers.
● 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.
● Documentation and reporting of data and trends.
● Strong ability to collaborate with others for mutually beneficial outcome.
● Ability to interpret clinical information and assess implications for treatment.
● Ability to read, interpret, and apply complex rules and regulations.
● Ability to independently make decisions yet knowing when to elevate the decision.
● Ability to drive long distances when required.
● Current Arizona Registered Nurse License.
● Minimum of 1 year of Behavioral Health 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 systems.
• 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.
• Travel is required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12 .) And have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less then 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
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.