Public Health Nursing Consultant – Behavioral Health and Prior Authorization
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AHAHCARE’S Mission: Deliver comprehensive, cost‑effective health care to Arizonans in need. The agency is nationally acclaimed and receives multiple awards for workplace effectiveness and flexibility. Employees are passionate, committed to high performance, and dedicated to serving the citizens of Arizona. The agency offers meaningful career opportunities, including remote work options and career paths for seasoned professionals, entry‑level positions, and internships.
Job Summary
This position will provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for FFS members’ physical/acute care services and behavioral health needs. Responsibilities include monitoring over- and under‑utilization, conducting reviews, coordinating care, providing referral and clinical staffing as needed, and serving as a resource for medically necessary covered services.
Major Duties and Responsibilities
Review clinical documentation to monitor, evaluate, and authorize healthcare services. Verify medical necessity, appropriateness of services, quality of care, and compliance with contractual State and Federal obligations.
Obtain, review, analyze, and discuss report and data findings to identify, monitor, and evaluate specialized intervention strategies and outcomes for member populations, including SMI and TRBHA.
Collaborate with AHCCCS providers—including SMI clinic, TRBHA, Medical Home, or other treatment team members—to provide technical assistance, training, and consultation. Serve as backup for BH Prior Authorization/Utilization Review unit and other CMSU functions as needed.
Coordinate with internal and external customers, make referrals as necessary, participate in clinical staffing, and serve as an FFS health plan subject‑matter expert.
Assist in the development of policies and procedures for the delivery of covered behavioral health services.
Knowledge, Skills and Abilities (KSAs)
Service Authorization concepts, principles, and strategies.
Behavioral health service delivery system and the needs of individuals designated as SMI.
Principles of behavioral health and medical nursing management and assessment.
Individual service planning process and substance abuse treatment.
HCPCS codes Levels I & II, and knowledge of ICD, DSM IV/V coding and medical billing guidelines.
Medical technology, computer data retrieval, and input—including EHR, HIE, etc.
Medicaid and Medicare Federal Regulations, State Statute, Rules, and Policies applicable to AHCCCS programs.
AHCCCS program design and implementation, prior authorization functions and responsibilities, provider network, and funding source.
Familiarity with American Indian Tribes, programs and policy.
Skills
Problem solving, identification, evaluation, and implementation of appropriate action in nursing and case management assessment.
Excellent verbal and 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 for working with people of diverse cultures and socioeconomic backgrounds.
Documentation and reporting of data and trends.
Abilities
Strong ability to collaborate with others for mutually beneficial outcomes.
Interpret clinical information and assess implications for treatment.
Read, interpret, and apply complex rules and regulations.
Independent decision making with knowledge of when to elevate the decision.
Selective Preferences
Arizona Driver's License.
Minimum Requirements
Possession of a current license to practice as a registered nurse in the State of Arizona and three (3) years of relevant experience.
Preferred Requirements
Professional experience in the Healthcare Industry—specifically experience in Prior Authorization, Concurrent Review, Retrospective Review, and Utilization Management.
Pre‑Employment Requirements
Successfully pass fingerprint background check, prior employment verifications, and reference checks. Employment is contingent upon completion of the above process.
Travel may be required for state business. Employees who drive on state business must complete any required driver training.
All newly hired state employees must successfully complete Electronic Employment Eligibility Verification Program (E‑Verify).
Benefits
10 paid holidays per year.
Paid vacation and sick time off (13 and 12 days per year, respectively, prorated for part‑time employees).
Paid parental leave—up to 12 weeks per year for newborn or newly placed foster/adopted child.
Other leave options—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.
Variety of learning and career development opportunities.
Remote work is a management option and not an employee entitlement. An agency may terminate a remote work agreement at its discretion.
By providing the option of a full‑time or part‑time remote work schedule, employees enjoy improved work/life balance, higher job satisfaction, and greater productivity.
Learn more about the Paid Parental Leave pilot program and the complete list of benefits provided by the State of Arizona on the official benefits page.
Retirement Program
Lifetime Pension Benefit Program: Administered through the Arizona State Retirement System (ASRS). Defined benefit plan that provides 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.
Deferred Retirement Compensation Program: Voluntary participation; administered through Nationwide; tax‑deferred retirement investments through payroll deductions.
Contact Information
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or other 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.