Clinical Operations Nurse Liaison

Department Information

State Of Colorado Residency Required At Time Of Application

NOTE: This announcement may be used to fill multiple openings.

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

We are looking for a Clinical Operations Nurse Liaison to join our Clinical Operations Division in the Cost Control and Quality Improvement Office !

As part of the State of Colorado, HCPF offers a competitive benefits package :

• Life and AD&D Insurance
• Accrued Sick Leave for State of Colorado Temporary Employees
• Flexible Spending Accounts (FSAs)
• Flexplace and Flextime work arrangements
• 11 Paid Holidays Annually and Accrued Annual and Sick Leave
• Automatic Short-Term and Optional Long-Term Disability Coverage
• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
• Reduced college tuition through CSU Global
• Medical , Dental , and Vision insurance coverage
• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
• Credit Union of Colorado Membership Eligibility
• Free RTD EcoPass to all eligible State Employees
• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs . https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

Description of Job

What You'll Be Doing

Position serves as a clinical nurse resource and expert to the Clinical Operations Division within the CCQI Office and for the entire Department. Position will report directly to the Clinical Operations & Utilization Management Section Manager and lead the triage of clinically related issues or questions that arise across the Department. Scopes of work consists of providing clinical expertise for policy and benefit design, medical necessity determinations, clinically related research and data analysis, access to care issues, and the review of complex members including navigating specialty populations such as pediatric members placed out of state in residential care. Position will implement clinical navigation services by using video technology for a subset of medically complex pediatric members utilizing Private Duty Nursing (PDN) to ensure members are accessing the most appropriate level of care and reduce inappropriate utilization. Position may also expand to include members receiving other fee for service benefits including pediatric behavioral therapy and home health services. Position supports the Clinical Operations Division by guiding program development and project plans, monitoring activities, and coordinating efforts of individuals in the Office to ensure that various projects are subject to timely and accurate implementation. This work includes, at a minimum, programmatic data and cost analysis, data sharing, stakeholder outreach, provider education, program design, assisting with contract and vendor management duties, and all work required to manage similar clinical operations programs.

Minimum Qualifications

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

Education And Experience

Current, valid licensure as a Registered Nurse from the CO Board of Nursing or any state participating in the Enhanced Nurse Licensure Compact (eNLC).

AND

A Master's degree from an accredited institution in a field of study related to the work assignment, along with three years of professional experience as a Registered Nurse serving a diverse population of patients to include developing and maintain effective working relationships with internal and external stakeholders.

OR

Current, valid licensure as a Registered Nurse from the CO Board of Nursing or any state participating in the Enhanced Nurse Licensure Compact (eNLC).

AND

A Bachelor's degree from an accredited institution in a field of study related to the work assignment, along with five years of professional experience as a Registered Nurse serving a diverse population of patients to include developing and maintain effective working relationships with internal and external stakeholders.

Substitutions

Additional appropriate experience will substitute for the degree requirement on a year-for-year basis.

Preferred Qualifications & Special Qualifications

• Clinical experience in a diversity of clinical settings with medically complex patients including an intensive or critical care unit.
• Experience synthesizing clinically related research and data analysis for program design and development guiding clinical research, program development and project plans.
• Experience with utilization management including prior authorization reviews and medical necessity determinations.
• Prior state experience related to the duties of this position
• Experience researching, developing, implementing, and overseeing clinical operations, programs, and/or health care policy management.
• Experience using different software for research and documentation
• Experience working as a registered nurse with patients with significant barriers to healthcare, to include knowledge around social determinants of health and how they affect care delivery.
• Nursing experience in private duty nursing in the home setting.
• Experience in care coordination or clinical navigation.
• Minimum of ten (10) years of professional experience as a Registered Nurse.

Highly Desired Knowledge, Skills And Abilities

• Ability to work with internal and external stakeholders to develop and maintain effective working relationships.
• Ability to work with data analysis, policy analysis, and program evaluation to develop solutions to problems, make recommendations to leadership, and implement policy, process, and programmatic improvements.
• Current knowledge of the healthcare industry and Colorado Medicaid, to include Colorado specific client access; quality; population health; and regional characteristics and challenges; Medicaid policies and practices; and federal and Colorado regulations and statutes.
• Ability to manage multiple projects or programs.
• Ability to draft formal reports for internal and external distribution and publication.

DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.

CONDITIONS OF EMPLOYMENT

• Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or any state participating in the Enhanced Nurse Licensure Compact (eNLC).
• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.

Appeal Rights

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email ([email protected]), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov ; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

Supplemental Information

How to Apply (PLEASE READ CAREFULLY)

Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.

Failure to submit properly completed documents by the closing date will result in your application being rejected.

ADAAA Accommodations : The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Virginia Miller, at [email protected] .

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.