drjobs Occupational Nurse Consultant (ONC/CQCT)

Occupational Nurse Consultant (ONC/CQCT)

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1 Vacancy
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Job Location drjobs

Olympia, WA - USA

Yearly Salary drjobs

$ 89904 - 147312

Vacancy

1 Vacancy

Job Description

Description

Occupational Nurse Consultant (ONC/CQCT)


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 division of Clinical Quality and Care Transformation (CQCT) makes clinical policy decisions to guide health care coverage to maintain quality standards ensure evidence-based practices for our clients healthcare and to support statewide care transformation.


About the position:

This Occupational Nurse Consultant (ONC) is responsible for implementing and managing statewide clinical programs and policies related todurable medical equipment. This position effectively manages these 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 evidence-based WAC criteria the principles of WAC and makes evidence based medical necessity determinations for client specific medical services which require prior authorization.


This position is eligible to telework and is typically not required to report on-site more than one (1) day a month. Occasional travel is required for work-related meetings trainings and contract monitoring.The default assigned work location of all Health Care Authority (HCA) positions both on-site and telework eligible positions is within the State of Washington. This position reports to Olympia WA. Frequency of onsite work will vary based on business and operational needs. HCA has currently suspended the ability to support out-of-state telework.

Duties

Some of what you will do:

  • Serve as clinical program manager for assigned programs implementing program goals and objectives. Developing and implementing policy and procedures clinical criteria WAC billing instructions and other relevant utilization management and quality assurance activities.
  • Collaborate with HCA management and staff in the formulation of statewide policy and clinical standards that ensure the delivery of quality care is rendered and services are appropriately utilized.
  • Work with staff to identify opportunities for education of HCA staff and community health care professionals to support program success.
  • Represents Medicaid in inter and intra agency initiatives including continuous quality improvement initiatives revisions to delivery of care models litigation negotiations.
  • Advises manager Medical Director division directors and executive leadership of need for new regulations formulating policy or modifying existing policy /regulation using data to support position including cost and utilization implications.
  • Make referrals to other department units and divisions or other state agencies including Quality Management Team Medical/Hospital Audit or Department of Health as indicated.
  • Provide consultative services to community health care professionals offering and negotiating covered less costly treatment options in lieu of the requested services to assure each clients needs are met.
  • Apply clinical knowledge and skills in evaluating client health care documentation and data in medical records.
  • Make independent clinical decisions about the adequacy appropriateness and conformance with accepted standards of care of services proposed by health care providers to make an authorization determination.
  • Negotiate and monitor contracts.
  • Perform liaison activities with other HCA and DSHS divisions the Department of Health Department of Corrections federal agencies and provider groups using clinical knowledge and expertise.

Qualifications

Required qualifications:


Qualifying candidates will meet one of the following criteria options:


Option 1:

  • A masters degree in nursing.
  • An active unrestricted Washington State Registered Nurse license or Multi-State License.
  • Two (2) years of clinical or functional nursing experience.
  • Two (2) years of related administrative consultative utilization or case management experience.

Option 2:

  • A bachelors degree in nursing.
  • An active unrestricted Washington State Registered Nurse license or Multi-State License.
  • Three (3) years of clinical or functional nursing experience.
  • Two (2) years of related administrative consultative utilization or case management experience.

Option 3:

  • An active unrestricted Washington State Registered Nurse license or Multi-State License.
  • Seven (7) years of clinical or functional nursing experience
  • Two (2) years of related administrative consultative utilization or case management experience.


Preferred qualifications:


  • Bachelor of Science Degree in Nursing or Bachelors in closely allied field.
  • Knowledge of HCA structure systems communication methods and forms.
  • Strong leadership communication and program management skills; including the ability to work across boundaries work both independently and collaboratively and meet deadlines.
  • Experience writing Medicaid State Plan Amendments Washington Administrative Code Medicaid Provider Guides and technical reports.
  • Ability to manage multiple activities establish priorities and advance assigned projects from inception to completion with limited supervision.
  • Provider One experience.
  • Working knowledge of the Affordable Care Act (ACA) and Medicaid rules and regulations.
  • Knowledge of coding principles/rules for ICD-10.


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.

  • 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 long-form copy) NGB 22 or USDVA signed verification of service letter.
  • Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in .

Supplemental Information

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:


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 A-U. 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 employee-led 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 Vandiverat or


The Washington State Health Care Authority (HCA) is anE-Verify employer. All applicants with alegal right to workin the United States are encouraged to apply.



E-Verify is a registered trademark of the U.S. Department of Homeland Security.



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Required Experience:

Contract

Employment Type

Full-Time

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