RN Outpatient Full-time
State of Arizona

Quality Assurance Nursing Consultant

State of Arizona Phoenix, AZ, US

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Quality Assurance Nursing Consultant

Division of Fee for Service Management (DFSM)

Job Location:

Phoenix - 150 North 18th Avenue Phoenix, Arizona 85007
Tucson - 7202 East Rosewood Street, Suite 125 Tucson, Arizona 85710

Posting Details:

Starting salary at $71,032 and may be increased based on experience and qualifications.

FLSA Status: Exempt

Grade: 22

Closing Date: Open until filled

Job Summary:

This position will work independently applying clinical knowledge, judgment, and expertise to assess, coordinate, and monitor service delivery. This position will complete comprehensive assessments of available resources on service providers and individual members; review case material to ensure compliance with State and Federal regulations and policies; and provide timely resolution of multiple cases assigned. This position will also be responsible for identifying systemic issues for AHCCCS to address.

This position will be hybrid with some in-office meetings, on-site investigations at least 20% of your time, and reviews as needed. Occasionally, this position may also participate as needed in urgent on-site investigations and reviews outside of normal business hours and weekends.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

 

Major duties and responsibilities include but are not limited to:
• Monitor compliance with State and Federal regulations pertaining to quality management processes, tracking, and trending quality of care concerns and/or health and safety/immediate jeopardy concerns. Receive, research, document, and resolve quality of care and/or health and safety issues utilizing standardized processes. Track, trend, and monitor the status of cases to ensure accurate and timely completion and appropriate referrals using a centralized case management tracking database. Ensure research and resolution of issues or concerns promptly as assigned and identify systemic issues for AHCCCS to address.
• Contributes clinical knowledge to assist in the resolution of quality of care concerns, clinical reviews and Operational Reviews. Completes an independent review of data management and other deliverables, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, action plans, provider education, and related actions as appropriate.
• Conduct on-site investigations regarding possible health and safety concerns, immediate jeopardy situations, and other situations supporting AHCCCS initiatives and ventures. On-site visits may also occur outside of normal business hours and weekends for immediate and urgent situations.
• Ensure quality of care to AHCCCS members, including ensuring member dignity and respect, focused on their unique special health care needs, timely correspondence, and resolution of the quality of care concern. Use independent judgment regarding data to research, status level, interventions, and appropriate resolution.
• Develop improved processes and procedures to improve the efficiency of the unit. Lead special projects and reviews to ensure completion within the designated timelines. Provide ongoing updates to Management.
• Develop metrics for population-specific outcome objectives. Tracking, evaluation, analysis, and revision of metrics as needed based on the ongoing analysis of member data.
• Provide education and technical assistance to internal and external stakeholders, as appropriate, regarding covered services, and contractual or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve quality of care and service to AHCCCS members.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
• State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, and LTC Supports and Services
• Current standards of medical/ behavioral practice and modes of delivery for acute and non-acute medical/behavioral care/services
• Data management and utilization review regulations, rules and processes
• AHCCCS and Medicaid regulations, policies, and procedures and applicable federal and state statutes, regulations and rules
• Medical/nursing practice, medical case management protocols, utilization review protocols as related to the acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, and behavioral/mental health
• Case management development, implementation, and ongoing review

Skill in:
• Acute nursing and clinical processes including assessment, planning, intervention, and evaluation
• Clinical assessment skill
• Techniques to select a particular approach to analyze develop or implement a policy, project management methodologies, and Behavioral Health delivery system
• Problem-solving techniques, evaluation, and initiation of appropriate action
• Excellent communication, verbal and written
• Organizational skills for setting priorities, workload, and record-keeping
• Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic backgrounds
• Project management to meet goals and deadlines
• Research and analytical skills
• Documentation and reporting of data and trends

Ability to:
• Strong ability to collaborate with others for a mutually beneficial outcome
• Interpret clinical information and assess implications for treatment
• Read, interpret and apply complex rules and regulations
• Independent decision making, yet knowing when to elevate an issue or concern
• Assess variables which impact health and functioning
• Make effective decisions in a high volume, fast paced environment
• Write comprehensive reports

Selective Preference(s):

Minimum: Must maintain a current Arizona medical license (RN or higher) or Arizona Behavioral Health license (Associate or higher) and 3 years of relevant healthcare experience. May require a valid Arizona Driver License for travel-related duties.

Preferred: Experience in Prior Authorization, Utilization Management, claims review, auditing, or managed care; knowledge of population served.

Pre-Employment Requirements:

• 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 may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.)

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.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits:

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 (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here.
• 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 (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities

By providing the option of a full-time or part-time 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.

Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

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.

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Telemetry Full-time
CommonSpirit Health

Nurse Neuro Telemetry

CommonSpirit Health Gilbert, AZ
Job Summary and Responsibilities As our Neuro Telemetry Nurse at Mercy Gilbert Medical Center, you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will leverage your expertise to provide individualized, comprehensive care, making critical assessments, performing skilled procedures, and meticulously implementing patient care plans. You'll collaborate seamlessly within an interdisciplinary team, contributing to a dynamic environment focused on optimal patient outcomes. To be successful in this role, you will possess keen assessment skills, acute critical thinking, and a patient-first mindset, driven by a profound enthusiasm to help others. Your sense of urgency and dedication to excellence in a fast-paced environment will not only support patient recovery but also fuel your own career advancement. Uses knowledge of cultural differences to provide patient care that is sensitive to and consistent with cultural values, beliefs, and customs Participates in the development of others through mentoring and precepting activities Engages and motivates others around the delivery of care Represents the organization in a positive manner Applies negotiation and conflict management strategies Dignity Health now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000. Join our team at Dignity Health to take advantage of this amazing opportunity! Job Requirements Required ADN or Diploma or Foreign Equivalent or BSN Registered Nurse: AZ American Heart Association BLS Preferred One (1) year medical/surgical acute experience Where You'll Work Hello humankindness Imagine a workplace where your passion for healing meets a commitment to community. At Mercy Gilbert Medical Center, a 198-bed non-profit facility, you'll be an integral part of providing exceptional, compassionate healthcare to the vibrant and growing communities in and around Gilbert, Arizona. Exciting News! Coming Soon: A State-of-the-Art Women's and Children's Pavilion will further enhance our specialized care for mothers and children. You belong here if you are: Committed to social justice. We believe everyone deserves equitable access to healthcare, regardless of background or circumstance. You'll contribute to a culture that champions fairness, dignity, and respect for all. Dedicated to health equity. We actively work to address disparities in healthcare and improve outcomes for underserved populations. Your skills will help us create a healthier community, one patient at a time. Prepared to deliver care in new, innovative ways. The healthcare landscape is constantly evolving, and we embrace forward-thinking approaches to patient care. We value creativity, adaptability, and a willingness to explore new solutions to complex challenges. Seek a collaborative and supportive environment. At Mercy Gilbert, you'll work alongside a diverse team of dedicated professionals who share your commitment to excellence. We foster a culture of teamwork, mutual respect, and continuous learning. Envision a career with purpose. Every day, you'll have the opportunity to make a tangible difference in the lives of individuals and families and the community. Your work here isn't just a job; it's a calling. Your skills are valued, your compassion celebrated, and your commitment to a healthier future empowered. Join us and make a lasting impact.
RN Telemetry Full-time
Dignity St. Mary's Medical Center San Francisco

Nurse Neuro Telemetry

Dignity St. Mary's Medical Center San Francisco Gilbert, AZ
Job Summary and Responsibilities As our Neuro Telemetry Nurse at Mercy Gilbert Medical Center, you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will leverage your expertise to provide individualized, comprehensive care, making critical assessments, performing skilled procedures, and meticulously implementing patient care plans. You'll collaborate seamlessly within an interdisciplinary team, contributing to a dynamic environment focused on optimal patient outcomes. To be successful in this role, you will possess keen assessment skills, acute critical thinking, and a patient-first mindset, driven by a profound enthusiasm to help others. Your sense of urgency and dedication to excellence in a fast-paced environment will not only support patient recovery but also fuel your own career advancement. Uses knowledge of cultural differences to provide patient care that is sensitive to and consistent with cultural values, beliefs, and customs Participates in the development of others through mentoring and precepting activities Engages and motivates others around the delivery of care Represents the organization in a positive manner Applies negotiation and conflict management strategies Dignity Health now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000. Join our team at Dignity Health to take advantage of this amazing opportunity! Job Requirements Required ADN or Diploma or Foreign Equivalent or BSN Registered Nurse: AZ American Heart Association BLS Preferred One (1) year medical/surgical acute experience Where You'll Work Hello humankindness Imagine a workplace where your passion for healing meets a commitment to community. At Mercy Gilbert Medical Center, a 198-bed non-profit facility, you'll be an integral part of providing exceptional, compassionate healthcare to the vibrant and growing communities in and around Gilbert, Arizona. Exciting News! Coming Soon: A State-of-the-Art Women's and Children's Pavilion will further enhance our specialized care for mothers and children. You belong here if you are: Committed to social justice. We believe everyone deserves equitable access to healthcare, regardless of background or circumstance. You'll contribute to a culture that champions fairness, dignity, and respect for all. Dedicated to health equity. We actively work to address disparities in healthcare and improve outcomes for underserved populations. Your skills will help us create a healthier community, one patient at a time. Prepared to deliver care in new, innovative ways. The healthcare landscape is constantly evolving, and we embrace forward-thinking approaches to patient care. We value creativity, adaptability, and a willingness to explore new solutions to complex challenges. Seek a collaborative and supportive environment. At Mercy Gilbert, you'll work alongside a diverse team of dedicated professionals who share your commitment to excellence. We foster a culture of teamwork, mutual respect, and continuous learning. Envision a career with purpose. Every day, you'll have the opportunity to make a tangible difference in the lives of individuals and families and the community. Your work here isn't just a job; it's a calling. Your skills are valued, your compassion celebrated, and your commitment to a healthier future empowered. Join us and make a lasting impact.
RN Telemetry Full-time
CommonSpirit Health

Nurse Neuro Telemetry

CommonSpirit Health Gilbert, AZ
Job Summary and Responsibilities As our Neuro Telemetry Nurse at Mercy Gilbert Medical Center, you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will leverage your expertise to provide individualized, comprehensive care, making critical assessments, performing skilled procedures, and meticulously implementing patient care plans. You'll collaborate seamlessly within an interdisciplinary team, contributing to a dynamic environment focused on optimal patient outcomes. To be successful in this role, you will possess keen assessment skills, acute critical thinking, and a patient-first mindset, driven by a profound enthusiasm to help others. Your sense of urgency and dedication to excellence in a fast-paced environment will not only support patient recovery but also fuel your own career advancement. Uses knowledge of cultural differences to provide patient care that is sensitive to and consistent with cultural values, beliefs, and customs Participates in the development of others through mentoring and precepting activities Engages and motivates others around the delivery of care Represents the organization in a positive manner Applies negotiation and conflict management strategies Dignity Health now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000. Join our team at Dignity Health to take advantage of this amazing opportunity! Job Requirements Required ADN or Diploma or Foreign Equivalent or BSN Registered Nurse: AZ American Heart Association BLS Preferred One (1) year medical/surgical acute experience Where You'll Work Hello humankindness Imagine a workplace where your passion for healing meets a commitment to community. At Mercy Gilbert Medical Center, a 198-bed non-profit facility, you'll be an integral part of providing exceptional, compassionate healthcare to the vibrant and growing communities in and around Gilbert, Arizona. Exciting News! Coming Soon: A State-of-the-Art Women's and Children's Pavilion will further enhance our specialized care for mothers and children. You belong here if you are: Committed to social justice. We believe everyone deserves equitable access to healthcare, regardless of background or circumstance. You'll contribute to a culture that champions fairness, dignity, and respect for all. Dedicated to health equity. We actively work to address disparities in healthcare and improve outcomes for underserved populations. Your skills will help us create a healthier community, one patient at a time. Prepared to deliver care in new, innovative ways. The healthcare landscape is constantly evolving, and we embrace forward-thinking approaches to patient care. We value creativity, adaptability, and a willingness to explore new solutions to complex challenges. Seek a collaborative and supportive environment. At Mercy Gilbert, you'll work alongside a diverse team of dedicated professionals who share your commitment to excellence. We foster a culture of teamwork, mutual respect, and continuous learning. Envision a career with purpose. Every day, you'll have the opportunity to make a tangible difference in the lives of individuals and families and the community. Your work here isn't just a job; it's a calling. Your skills are valued, your compassion celebrated, and your commitment to a healthier future empowered. Join us and make a lasting impact.
RN Telemetry Full-time
Virginia Mason Franciscan Health

Nurse Neuro Telemetry

Virginia Mason Franciscan Health Gilbert, AZ
Job Summary and Responsibilities As our Neuro Telemetry Nurse at Mercy Gilbert Medical Center, you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will leverage your expertise to provide individualized, comprehensive care, making critical assessments, performing skilled procedures, and meticulously implementing patient care plans. You'll collaborate seamlessly within an interdisciplinary team, contributing to a dynamic environment focused on optimal patient outcomes. To be successful in this role, you will possess keen assessment skills, acute critical thinking, and a patient-first mindset, driven by a profound enthusiasm to help others. Your sense of urgency and dedication to excellence in a fast-paced environment will not only support patient recovery but also fuel your own career advancement. Uses knowledge of cultural differences to provide patient care that is sensitive to and consistent with cultural values, beliefs, and customs Participates in the development of others through mentoring and precepting activities Engages and motivates others around the delivery of care Represents the organization in a positive manner Applies negotiation and conflict management strategies Dignity Health now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000. Join our team at Dignity Health to take advantage of this amazing opportunity! Job Requirements Required ADN or Diploma or Foreign Equivalent or BSN Registered Nurse: AZ American Heart Association BLS Preferred One (1) year medical/surgical acute experience Where You'll Work Hello humankindness Imagine a workplace where your passion for healing meets a commitment to community. At Mercy Gilbert Medical Center, a 198-bed non-profit facility, you'll be an integral part of providing exceptional, compassionate healthcare to the vibrant and growing communities in and around Gilbert, Arizona. Exciting News! Coming Soon: A State-of-the-Art Women's and Children's Pavilion will further enhance our specialized care for mothers and children. You belong here if you are: Committed to social justice. We believe everyone deserves equitable access to healthcare, regardless of background or circumstance. You'll contribute to a culture that champions fairness, dignity, and respect for all. Dedicated to health equity. We actively work to address disparities in healthcare and improve outcomes for underserved populations. Your skills will help us create a healthier community, one patient at a time. Prepared to deliver care in new, innovative ways. The healthcare landscape is constantly evolving, and we embrace forward-thinking approaches to patient care. We value creativity, adaptability, and a willingness to explore new solutions to complex challenges. Seek a collaborative and supportive environment. At Mercy Gilbert, you'll work alongside a diverse team of dedicated professionals who share your commitment to excellence. We foster a culture of teamwork, mutual respect, and continuous learning. Envision a career with purpose. Every day, you'll have the opportunity to make a tangible difference in the lives of individuals and families and the community. Your work here isn't just a job; it's a calling. Your skills are valued, your compassion celebrated, and your commitment to a healthier future empowered. Join us and make a lasting impact.
RN Outpatient Full-time
American Vision Partners

Registered Nurse - Surgery

American Vision Partners Mesa, AZ
Company Intro At American Vision Partners (AVP) , we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers. At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees! Overview As an Ophthalmology RN, your strong detail orientation and multi-tasking skills will be essential in our fast-paced, high-volume environment. You will provide a safe and efficient environment for all patients in our Ambulatory Surgical Center (ASC) during the perioperative phases Responsibilities Greets and admit patients to the pre-/post-operative area Assesses, plans, implements and evaluates patient care using the nursing process and take into account individual patient needs Prepares operating suite for patients - monitor cleanliness, assemble supplies, instruments and sutures, check equipment for proper functioning Assesses patient’s condition on arrival in surgery and provide physical or emotional support as needed Assists Anesthesia Provider and Surgeon during procedures, maintaining constant awareness of the operative situation and a safe environment for patients and personnel Evaluates, observes, and treats patients under local anesthesia Maintains accurate and complete records of patients’ surgical experience Starts IVs, gives medications, and prepares drugs and solutions per physician protocols Prepares for and manages immediate postoperative care, including transporting patients to recovery room, communicating patient needs, and providing patient and family training Assists in orientation of new team members and cross-training of existing personnel Obtains patient history through interviews and evaluations, noting data in chart and sharing pertinent information with physician Qualifications Associate’s degree required; BSN preferred Current RN License 1-year Ophthalmology experience as a Surgery RN is a plus BLS certification required ASC experience preferred Bilingual preferred Detailed oriented, reliable and able to multi-task in a fast-paced, high-volume work environment Excellent verbal and written communication skills This is a Safety Sensitive position Benefits & Perks Your health, happiness and your future matters! At AVP, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!