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Job Information
Job Title:  CONCURRENT / UTILIZATION REVIEW NURSE 
Agency:  DEPARTMENT OF CHILD SAFETY 
Job Reference ID:  57424 
Category:  MEDICAL/HEALTH SERVICES 
Grade:  21 
Posted Date:  07/23/2020 
Close Date:   
Job Description



Arizona Department of Child Safety

A New Beginning for Arizona’s Children

 

CONCURRENT/UTILIZATION REVIEW NURSE
COMPREHENSIVE MEDICAL AND DENTAL PROGRAM (CMDP)
3003 N. Central Avenue
Phoenix, AZ 85012

www.azdcs.gov

 

DCS Mission Statement

Successfully engage children and families to ensure safety, strengthen families, and achieve permanency.

JOB SUMMARY:

Are you ready to help reshape and reinvent Arizona health care?  The Arizona Department of Child Safety (DCS) is going beyond basic health care to a health care program integrated across the entire continuum of care.

 

DCS is looking for an experienced nurse who would be responsible for reviewing children’s medical records and medical cases and ensuring our children are receiving the most appropriate care.    Additionally, this nursing position will be responsible for the delivery of clinical healthcare services for one of the DCS’s comprehensive clinical programs listed below:

 

·         Quality Management and Performance Improvement (QM/PI),

·         Medical Management (MM),

·         Behavioral Health (BH),

·         Maternity and Family Planning (Mat and FP)

         Early Periodic Screening Diagnostic and Treatment (EPSDT). 

 

**The Comprehensive Medical and Dental Program (CMDP) is the health plan responsible for ensuring, in partnership with foster care providers, the provision of appropriate and quality health care services for the well-being of Arizona's children in foster care**

JOB DUTIES: 

-          Perform healthcare utilization management, prior authorization, concurrent hospital review, medication authorizations and perform care coordination for children in foster care throughout the state of Arizona

-          Collaborates with case managers, behavioral health systems, early intervention, and Medicaid in the service coordination of highly complex cases.

-          Administer statewide AHCCCS mandated programs (QM/PI, MM, Mat and FP, or EPSDT) which includes policy development, reporting, auditing, correspondence, training, and program compliance.

-          Represent CMDP in external meetings and activities with AHCCCS, Department of Health Services, healthcare providers and other DCS divisions related to assigned program area.

-          Interpret and apply statutes, regulation, an AHCCCS policy and rules; develops reports, Notices of Action (NOA), policies, correspondence and other written materials of a complex and professional nature.

-          Provide technical assistance to the CMDP Program Administrator, Medical Directors, Unit Managers and staff; and will be responsible for staff development for non-clinical medical services staff.

-          Performs other duties appropriate to the assignment

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of:

-          DCS policies, procedures, and current State Federal and local laws governing AHCCCS/Medicaid health plan operations and requirements

-          Healthcare administration as it relates to children in foster care

-          Clinical standards and quality of care

Skill in:

-          Excellent verbal and written communication

-          Clinical problem solving

-          Clinical management and leadership practices

Ability to:

-          Plan, organize and administer clinical care coordination within Arizona’s systems of care; the foster care system and related agencies

-          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 

PRE EMPLOYMENT REQUIREMENTS: 

-          Current, active AZ RN license; in good standing with AZ Nursing Board. Must be able to secure and maintain clearance from the CPS Central Registry.

-          Employment is contingent on the selected applicant passing a background investigation.

PREFERRED QUALIFICATION(S):

-          Experience working within Arizona's systems of care.

BENEFITS: 

We offer a comprehensive benefits package that includes: 

-          Sick leave

-          Vacation with 10 paid holidays per year

-          Health and dental insurance

-          Retirement plan

-          Life insurance and long-term disability insurance

-          Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

RETIREMENT: 

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.

 

 

 
Position Requirements
Position Level:    Hours:   
 Work Arrangement:     Employment Type:   
Hourly Rate:  $0.00 / per hour  Salary:  $70,000.00-70,000.00 

 

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