Nursing Consultation Advisor NCACQCT - Internal

Nursing Consultation Advisor (NCA/CQCT)

This opportunity is internal and available to current HCA employees only.

Functioning as both the states largest health care purchaser and its behavioral health authority the Washington State Health Care Authority is a leader in ensuring Washington residents have the opportunity to be as healthy as possible. There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars HCA purchases health care including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention crisis and recovery supports to all Washington residents.

All HCA employees will apply an equity lens to their work which may include but is not limited to all analyses of core business and processes.

About the division:

The Clinical Quality and Care Transformation (CQCT) Division is responsible for making clinical policy decisions that guide medical coverage maintain quality standards and ensure evidencebased practices for consumers medical care.

About the position:
This position is responsible for implementing and managing statewide clinical programs and policies. The clinical policies and services addressed by this position impact 1.8 million Medicaid clients. This position effectively manages clinical programs including implementing policies and applying best practices principles in utilization management and quality of care standards that contribute to over $2 billion in federal and state Medicaid Title XIX Titles XXI and state funds. In addition this position applies utilization review principles as well as evidencebased WAC criteria the principles of WACand makes evidencebased medical necessity determinations for client specific medical services which require prior authorization.

Some of what you will do:

• Serve as clinical program manager for assigned programs implementing program goals and objectives policy and procedure clinical criteria WACS billing instructions and other relevant utilization management and quality assurance activities.
• Collaborate with CQCT management staff in the formulation of statewide policy and clinical standards that ensure quality care is rendered and services are appropriately utilized.
• Work with staff to identify opportunities for education of CQCT staff and community health care professionals to support program success.
• Review and evaluate available scientific evidence based clinical policy decisions and health care benefit coverage decisions.
• Facilitate and collaborate with stakeholders in the development and design of program changes or new programs including development of action plans policy criteria and training.
• Conduct analysis of clinical data evaluating the success of the program and progress towards program objectives in conjunction with the clinical program manager prepare reports of analysis including recommendations for program modifications or discontinuation if indicated.
• Provide consultative services and apply current concepts in nursing and utilization review combined with clinical knowledge and skills to ensure clients receive medically necessary quality care.
• Review and evaluate available scientific evidence to apply evidence based clinical policy when making utilization review determinations meeting requirements of WAC .
• Triage workload and provide coverage as required to assure clients have timely access to care. Assess staffs compliance with WACs and appropriate applications of utilization review criteria or treatment guidelines and use of ProviderOne and other systems available to them to complete their daily work assignments.

Required qualifications:

A valid Washington State or MultiState license to practice as a registered professional nurse.

AND

• Master of Science degree in Nursing AND three years management or consultative experience in health services or Medicaid programs.

OR

• Bachelor of Science degree in Nursing AND five years management or consultative experience in health services or Medicaid programs.

OR

• Associate of Science degree in Nursing or graduate from a threeyear Diploma Nursing program may apply if you also hold an undergraduate (Bachelors) degree or graduate (Masters) degree with major study in public health public administration business administration nursing healthcare administration or closely allied field and five years of management or consultative experience in health services or Medicaid programs.

AND

• Ability to plan organize and direct staff responsible for prior authorization of medical care.
• Knowledge and application of standards of medical practice medical records medical procedures and ethics pharmaceuticals and current clinical practice guidelines e.g. M&R URAC InterQual and JCAHO to assess appropriateness of care or requested services.
• Knowledge and application of methods and practice of evidence gathering and processing interviewing and confidentiality.
• Knowledge and ability to conduct literature reviews and apply evidencebased medicine principles in clinical decision making.
• Ability to analyze data and medical records applying utilization review principles to determine how medical practices affect client health and safety and whether the request meets accepted clinical practice guidelines to make authorization determinations.
• Demonstrate clear concise accurate and effective oral and written communication of clinical facts and recommendations directed to healthcare providers professional and paraprofessional staff in government and nongovernment organizations and the public.
• Ability to establish and maintain effective relationships with providers and staff in HRSA and other agencies.
• Ability to work effectively in a team with peers managers health care providers and others.
• Knowledge and ability to use computer software programs e.g. Word Excel MMIS HWT Hayes MDConsult.
• Ability to facilitate meetings effectively with interdisciplinary groups and provide education or training when needed.

Preferred qualifications:

• Knowledge and application of federal and Washington State rules and regulations related to health care and Medicaid.
• Knowledge and application of coding principles/rules for ICD9 CPT and ICD10.

How to apply:
Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile which includes three professional references and attach in separate files:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume

To take advantage of veteran preference please do the following:

• Attach a copy of your DD214 (Member 4 longform copy) NGB 22 or USDVA signed verification of service letter.

About HCA:
Functioning as both the states largest health care purchaser and its behavioral health authority the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars HCA purchases health care including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention crisis and recovery supports to all Washington residents.

What we have to offer:

• Meaningful work with friendly coworkers who care about those we serveVoices of HCA
• A clear agency mission that drives our work and is personcenteredHCAs Mission Vision & Values
• A healthy work/life balance including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit packageWA State Government Benefits
• A safe pleasant workplace in a convenient location with restaurants and shopping nearby.
• Tuition reimbursement
• And free parking!

Notes:

Please note salary is based on experience and is determined at the time a final offer of employment is made. Per State HR guidance nursing salaries are considered a special pay range and details on that range can be found here: N Range details. The salary range listed in the job posting includes steps AU. Step U is a longevity step and is typically gained six years into being assigned step T in your permanent salary range.

Prior to a new hire a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected included and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary employeeled groups whose aim is to foster a diverse inclusive workplace aligned with HCAs mission.Our diversity and inclusion efforts include embracing different cultures backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women racial and ethnic minorities and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age disabled and Vietnam era veterans as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them please contact us at . Persons with disabilities needing assistance in the application process or those needing this job announcement in an alternative format may contact Leila Vandiver ator

The Washington State Health Care Authority (HCA) is an EVerify employer. All applicants with a legal right to work in the United States are encouraged to apply.

EVerify is a registered trademark of the U.S. Department of Homeland Security.

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