Occupational Nurse Consultant (Onc/Mpd)

Occupational Nurse Consultant (ONC/MPD)

71089063

The Legislature has also approved a 3% general wage increase for all state employees, effective July 1, 2024

HCA is seeking an Occupational Nurse Consultant (ONC) who has experience working with individuals with Intellectual or Developmental Disabilities (IDD) to provide oversight and consultation for the Developmental Disabilities Administration (DDA) care and services. This role focuses on reducing barriers to individual care, improving system design to prevent service gaps, and coordinating with partners for comprehensive support. If you enjoy using your clinical judgment to enhance care quality for individuals with IDD, this may be the opportunity for you!

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 Mission of Medicaid Program Division (MPD) 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 health care services to qualified Washington state citizens. MPD staff work across the agency and between agencies (Department of Health, Department of Social and Health Services, etc.) 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 clients' ability to access appropriate, quality health care.

About the position:

The ONC serves as a Systems Coordinator to provide clinical consultation and systems planning and connections to ensure individuals with special needs have their health care needs addressed in the managed care delivery system, including Managed Care Organization (MCO), Behavioral Health Administrative Services Organization (BH-ASO), and Dual Eligible Special Needs Plan (DSNP) systems of care. This position uses clinical expertise and judgment to provide oversight and direction to the delivery system to better serve individuals and efficiently use resources.

This position is eligible to telework but may be required to report on-site to meet business needs.  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. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis.

Some of what you will do:

• Individual case investigation and resolution of enrollees experiencing difficulty or delay accessing medically necessary services. Focus on special populations, such as those involved in multiple systems, individuals with co-occurring behavioral health diagnoses, medically complex clients, and individuals with intellectual or developmental disabilities.

• Coordinate seamless services for individuals with Intellectual/Developmental Disabilities, especially those with co-occurring conditions transitioning between and within state systems and Medicaid authorities (i.e., State Plan and Waiver), with focus on the managed care delivery system.

• Collaborate to resolve barriers to quality and timely care with system partners, such as Developmental Disabilities Administration (DDA), Aging and Long-Term Support Administration (ALTSA), and providers. Work with contractors (MCOs and BH-ASOs) and other HCA staff to investigate individual cases and identify ways to improve overall services.

• Provide oversight and direction to the delivery system to better serve individuals and efficiently use resources.

• Review of client health care utilization history, claims/encounter history, managed care enrollment, and/or medical records, as appropriate.

• Use available information, including individual client situations, system partner feedback, and compliance review activities, to inform system planning and barriers identification.

• Consult, monitor, and review quality and timeliness of care and services provided to the population served within the delivery system, focusing on special populations.

• Provide oversight and direction to the delivery system to better serve individuals and efficiently use resources.

• Identify, problem-solve, and work for resolution to system barriers to prevent barriers affecting other clients.

• Coordinate with peers, other State agencies, and CMS as directed to provide Medicaid oversight and enforcement activities as needed to ensure appropriateness of State Plan Amendment (SPA) services are provided to residents.

• Provide clinical judgment and expertise to perform compliance review, monitoring and oversight to DSHS-recommended RHC enforcement remedies.

• Support agency compliance role in use of appropriate enforcement remedies to match the level of noncompliance, including development and implementation of alternate remedies.

• Written analysis of proposed legislation with potential implications on the contracted managed care delivery system. Provide written narrative analysis as part of review of legislation. Coordinate with section staff.

• Support agency response to legislative reporting.

Required qualifications:

• Current Registered Nurse licensure in Washington State.

AND

• Three (3) years' experience in care coordination or nursing care for special needs populations.

• Two (2) years of consultative, administrative or supervisory experience with registered nursing staff or other health care professionals. 

• A bachelor's degree will substitute for the two years of administrative, consultative or supervisory experience

Preferred qualifications:

• Two (2) years' experience working with individuals with intellectual or developmental disabilities and Medicaid systems serving them.

• Two (2) years' experience in quality assurance and improvement principles and approaches.

• Experience in Medicaid managed care operations. • Experience in contract management and accountability.

• Facilitate timely communications and interchange between diverse groups of internal and external stakeholders, agencies, providers, and the public.

• Independently manage competing timelines to meet critical deadlines and handle multiple projects at a time.

• Analyze and resolve complex problems related to managed care delivery system.

• Collaborate across health care purchasing systems, build teams and work cooperatively with internal and external resources to support program development.

• Ability to write clear, narrative, analytical reports.

• Public relations and customer service skills, including conflict resolution and negotiation techniques.

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:

• 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 careers.wa.gov.

About HCA:

Functioning as both the state's 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 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.

• A great total compensation and benefit package WA 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 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 HCA's 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 HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Julie Laney at (360) 725.5130 or julie.laney@hca.wa.gov.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in 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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