Occupational Nurse Consultant Supervisor Details

Occupational Nurse Consultant Supervisor

State of Washington Health Care Authority - Olympia, WA

Employment Type : Full-Time

Description

Occupational Nurse Consultant Supervisor (ONCS/MPOI)71079431

What we have to offer you

• Meaningful work with friendly co-workers who care about those we serve Voices of HCA
• A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• Infants in the workplace Infants at the Workplace Video
• A great total compensation and benefit package WA State Government Benefits
• Tuition Reimbursement.

Context:
The Mission of the Medicaid Program Operations and Integrity (MPOI) Division in the Health Care Authority (HCA) is to provide high quality health care through innovative health policies and purchasing strategies which assist in the purchase and delivery of medical services to qualified Washington citizens. MPOI staff works across the agency and between agencies (Department of Health, Department of Social and Health Services) and in partnership with health care providers and community stakeholders to develop and manage high-quality, evidence-based, health care programs and purchasing of services that enhance Apple Health clients’ ability to access appropriate, quality health care. MPOI is responsible for the implementation and oversight of Washington Apple Health managed care programs, including Managed Care Organizations (MCO) and Behavioral Health Administrative Services Organizations (BH-ASO), serving over 1.5 million Washington residents in all 39 counties. Through these efforts, the position supports HCA’s mission to “Provide high quality health care through innovative health policies and purchasing strategies.”

About the position:
This position reports directly to the Section Manager of Medicaid Compliance Review and Analytics (MCRA), and provides direct supervision of the Specialized Services and Oversight Unit, including Patient Review and Coordination (PRC) Unit and the Pre-Admission Screening and Resident Review (PASRR) teams. This includes: Two Medical Assistance Program Specialist-1 (MAPS 1); two Medical Assistance Program Specialist-2 (MAPS 2); two Medical Assistance Program Specialist-3 (MAPS 3); and two Occupational Nurse Consultant (ONC).

The ONCs reporting to this position serve as system coordinators, providing clinical consultation and oversight to the case management services provided by the managed care organizations to special population clients, including those who are receiving services from Developmental Disabilities Administrations (DDA), Aging and Long-Term Support Administration (ALTSA), or under the peruse of Department of Children Youth and Families (DCYF). Implementation of DSHS-recommended compliance/enforcement activities related to Residential Habilitation Centers (RHCs), in coordination with HCA executive leadership, is addressed by the ONC Systems Coordinator in partnership with the ONC Supervisor.

The PRC team is responsible to: decrease and control over-utilization and inappropriate use of health care services within the Fee-for-Service (FFS) and Managed Care programs; minimize medically unnecessary services and addictive drug use. For the FFS program, unit staff make direct referrals through the use of health care algorithms; provide client and provider education and coordination of care; assist providers in managing PRC clients by providing available resource information to facilitate coordination of care; and reduce overall expenditures. For the Managed Care programs, unit staff monitor and provide oversight, as well as technical guidance, to assure MCO fulfillment of their responsibilities to accomplish the goals of the PRC program and be compliant with the MC contract(s). Unit staff will take corrective action, as indicated.

PASRR is a federally-required screening process for every person referred to a Medicaid-licensed Nursing Facility (NF). The PASRR team is responsible to coordinate the Level II screening process using Contractors who evaluate the need for Behavioral Health Specialized Services: track completion of Level II screens; provide quality assurance; and provide ongoing technical assistance to NF providers.

Some of what you will do in this role:

• Supervision of Unit staff responsible for managing inquiries, complaints, feedback and policy questions received through email, letter or phone and writing and implementing written policy for the Managed Care program.
• Support agency’s role with contractor compliance regarding quality, timeliness, and access to health care services.
• Accountable for PRC unit staff conducting analyses and determination of medical necessity while evaluating frequency of physician visits, emergency room visits, and prescription drug usage for FFS clients that are being considered for placement into the PRC program and providing oversight and technical assistance to the MCOs in their performance of these responsibilities for enrollees consistent with code of federal regulations and the MCO contract.
• Accountable for PASRR unit staff coordinating the Behavioral Health Level II screening process.

Required Education, Experience

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

AND

• Two years of experience as an Occupational Nurse Consultant

OR

• 3 years of clinical or functional nursing experience. A Master's degree in a health care field will substitute for one year of nursing experience.
• 4 years of consultative, administrative or supervisory experience over registered nursing staff or other health care professionals. A Bachelor's degree will substitute for two years of administrative, consultative or supervisory experience.
• At least 2 years’ experience with quality assurance and improvement principles and approaches.
• 3 years monitoring complex contracts and at least one-year developing, overseeing or writing contracts.

Preferred/Desired Qualifications:

• A master’s degree in Nursing, Business Administration, Public Administration or Public Health is preferred.
• Demonstration of the ability to gather information from a variety of resources. Condense content and produce comprehensive, informative reports.
• Experience in managed care operations and thorough understanding and experience of managed care programs.
• Working knowledge of medical terminology and interpretation of health care documentation.
• Ability to lead teams and build consensus.
• Knowledge of healthcare auditing concepts and principles.
• Three years Medicaid or other healthcare-related field experience.
• Working experience conducting medical record reviews and ability to interpret and apply Federal and State regulations, coding and billing requirements.
• Knowledge and understanding of CPT, ICD-9, ICD-10, and HCPCS coding principles.
• Proficient in the use of Microsoft software, including Word, Excel, Access, and PowerPoint.

About HCA:
The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.
HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
How to Apply:
Only candidates who reflect the minimum qualifications on their State application 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 and attach:

• A letter of interest with specific language on why you are interested this position. No more than two pages in length.
• A current resume that is no more than two pages in length.
• A list of contact information for three professional references, including at a minimum one current or previous supervisor.
• Please attach a document describing your experiences and commitment to diversity, equity, and inclusion by addressing:
  • Your personal and professional values related to diversity, equity, and inclusion.
  • Your lived experiences working with and supporting diverse and marginalized communities, including, but not limited to: ethnic/racial minority communities, Tribal members and urban Indian populations; individuals with a disability; deaf and hard of hearing; non-English speaking individuals; lesbian, gay, bisexual, transgender and questioning communities; court system involved, people who have experienced homelessness, and other under-served or marginalized communities.
  • If offered this position, how would you advocate for and what would you do to promote and support diversity, equity, and inclusion at HCA?

If you have questions about the process, or need reasonable accommodation, please contact Sanyu Tushabe before the posting closes.

Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1180 or email Dennis.Lienemann@hca.wa.gov

* 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 but will be considered in determining the applicant's suitability and competence to perform in the position. *