Washington State Occupational Nurse Consultant in Olympia, Washington


Occupational Nurse Consultant One-year Non-Permanent Olympia, WA

The Health Care Authority is looking for a registered nurse to join our team of nurses, pharmacists, physicians and other state employees that work closely to create and update Medicaid benefit and reimbursement policies and procedures.

You would be part of the Clinical Quality and Care Transformation team as a program manager. As a program manager you would be in charge of one or more Medicaid programs. The work you do may include making updates to provider guides, WAC's and SPA's, corresponding with internal and external stakeholders, providers and clients. You may also work with other state agencies with the ultimate goal being to best serve the 1.8 million Washingtonians who are Medicaid recipients. During the legislative session you would be responsible for reviewing legislative house and senate bills that relate to your programs and giving feedback on the impact they may have on Medicaid benefits. This is an exciting and challenging role for a nurse and offers the opportunity to really impact the most vulnerable residents of Washington.

About the Health Care Authority: The Health Care Authority (HCA) is Washington's largest health care purchaser, responsible for providing comprehensive health coverage to more than 2 million residents through the Public Employees Benefits and Medicaid programs. The agency provides health purchasing leadership, benefiting both public and private sectors with a focus on moving the health delivery system away from volume toward higher value and better outcomes.

The Olympia office is located in downtown Olympia, within walking distance of shops, restaurants, bus lines, and less than one (1) mile from the freeway.

Position Objective: This position is responsible for implementing and managing statewide clinical programs and policies. 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 evidence-based WAC criteria, the principles of WAC 182-501-0165, and makes evidence-based medical necessity determinations for client specific medical services which require prior authorization.

This position will perform the following work:

Manage policy and day-to-day work associated with assigned clinical program(s).

  • 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 insure the delivery of quality care is rendered and services are appropriately utilized. Conduct utilization review and make prior authorization and claim payment determinations, as required, for services under assigned clinical program(s) and as assigned. Participate in hearings and their preparation related to utilization review denials.
  • Provide consultative services and apply current concepts in nursing and utilization review, combined with clinical knowledge and skills to assure 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 182-501-0165. Qualifications Required Qualifications:

  • Graduation from an accredited school of nursing and two years' experience working with low-income individuals and families

  • Current Washington State RN license
  • Knowledge and application of standards of medical practice, medical records, medical procedures and ethics, pharmaceuticals, and current clinical practice guidelines
  • Knowledge and ability to conduct literature reviews and apply evidence-based medicine principles in clinical decision making. Preferred/Desired Qualifications:

  • Bachelor of Science Degree in Nursing or Bachelor's in closely allied field

  • Working knowledge of the Affordable Care Act (ACA) and Medicaid rules and regulations.
  • Knowledge of coding principles/rules for ICD-10.

Please Note the Following: Application assessment will be ongoing and the hiring authority reserves the right to offer the position at any time during the recruitment process. It is to the applicant's advantage to apply as early as possible.

*How to Apply: * Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile within http://careers.wa.gov and attach to your profile before completion:

  • A cover letter
  • Current resume
  • Three professional references Only candidates who reflect the minimum qualifications on their State application will be considered.

If you have questions about the process, or need assistance, please contact the recruiter listed below before the posting closes. The candidate pool certified for this recruitment may be used to fill future similar vacancies for up to the next six months.

Contact us: * For inquiries about this position, please contact *Sanyu Tushabeat 360-725-1180 or email to Sanyu.Tushabe@hca.wa.gov. **Persons under final consideration for initial appointment with HCA are subject to a background check.

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 360.725.11180 or emailSanyu.Tushabe@hca.wa.gov.

Job Type: Full Time - Non-Permanent

Job Number: 2016-10430

Department: Health Care Authority

Closing: Continuous

Agency: State of Washington

Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504.

Website: http://www.careers.wa.gov

Salary: $58,056.00 - $95,184.00 Annually

Location: Thurston County – Olympia, WA