Clinical Nurse Specialist Manager (CNS/MPOI)
$7,398.00 - $12,131.00
The Health Care Authority is seeking an accomplished individual to collaborate at a high level with senior managers and stakeholders to develop solutions and influence decisions that drive progress on health care issues that impact all Washingtonians. The ideal candidate for this position will have a passion and experience with health care. If you have experience with health services, social service, Medicaid or social security disability programs, this opportunity may be for you!
This position serves as manager of the Medicaid Compliance Review and Analytics (MCRA) section in the Medicaid Program Operations and Integrity (MPOI) Division of Health Care Authority's Medicaid program. This Clinical Nurse Specialist position reports directly to the Director of the Division of Medicaid Program Operations and Integrity and manages twenty-eight employees.
Some of what you will do:
- Manages a clinical unit composed of nine (9) licensed staff and sixteen (16) non- licensed staff in the Medicaid Compliance and Analytics Section within MPOI.
- Manages and supervises staff responsible for the oversight and monitoring of HCA's managed care organizations' (MCO) quality of care performance and compliance with the contract scope of work through clinical review.
- Develops contract language to modify or add to scope of work as required to improve compliance and performance of Contractor(s).
- Develops clinical performance monitoring tools and designs and implements corrective action initiatives; evaluates MCOs' success with corrective action.
- Implements clinical processes and initiatives aimed at improving MCO performance and compliance with the contractual scope of work.
- Provides leadership and sets direction for MCO oversight and monitoring, including specifically identifying special target areas of care.
- Provides leadership in clinical processes, coaching and mentoring staff on utilization review, applying evidenced-based care guidelines or pathway to care to determine clinical care interventions, coordination/discharge planning, identifying appropriate covered benefits, resources for medically necessary treatment and support services to support timely intervention and measurable outcomes.
- Manages a health care data analytics unit composed of three (3) data analysts in the Medicaid Compliance and Analytics Section within MPOI.
- Implements health care quality performance measures and value-based purchasing initiatives in the Medicaid managed care contracts.
Here is what we are looking for (Required Qualifications):
Bachelor of Science Degree in Nursing.
Active Washington State Licensure to practice as a registered, professional nurse.
Five (5) years' experience in healthcare.
Three (3) years' experience in professional nursing, with expertise in managed care, utilization review/management, quality of care, care coordination or clinical processes or managing these activities.
Three (3) years' experience in staff supervision or lead responsibilities; supervising licensed and non-licensed staff.
Skills and abilities:
- Professional nursing principles and techniques
- Dynamics of interpersonal relationships
- Managed care principles
- Best practices in utilization review and management theory, concepts and program design
- Quality of care principles and evaluation
- Care coordination and case management; availability of community resources and programs
- Health care policy, benefit management, clinical guidelines
- How to access and use state resources
- Expectations and responsibilities of supervision; managerial technique
- Washington Medicaid State Plan and Alternative Benefit Package
- Code of Federal Regulations applicable to Medicaid
- Health Care Authority's WACs and policy, including administrative policy
- Diagnosis (ICD-9/10) and procedure (CPT, CDT, HCPC) coding
- Legislative and budget process
- Collective Bargaining Agreement
- Claims data
About the HCA:
The Washington State Health Care Authority (HCA) purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. Our agency is committed to whole person care, integrating physical health and behavioral health services for better results and healthier residents. 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.
About Olympia and Washington State:
Washington State offers a total work/life package of pay, benefits, flexibility, and workplace opportunities to help you get the most out of your career and out of life. Washington State is a great place to work, play, and be a part of a community, offering quality of life that is unsurpassed. From the high energy urban center of Seattle, one of the nation's top ranked cities, to the more relaxed pace of our rural communities, Washington's distinctive Northwest lifestyle blends a progressive, creative culture with a casual nature.
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 and attach:
- A cover letter that specifically addresses how you meet the qualifications for this position.
- Current resume
- Three professional references
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 Sanyu.Tushabe@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. *
Job Type: Full Time - Permanent
Location: Thurston County – Olympia, Washington
Agency: Health Care Authority