NURSE MANAGER

DEPARTMENT OF ECONOMIC SECURITY

Your Partner For A Stronger Arizona.

Job Location:

4000 N. CENTRAL AVENUE PHOENIX, AZ 85012

Posting Details:
Salary: $87,582.00 - $90,749.86 | Grade: N2 | Closing Date: 1/19/2026

Would you like to be part of an amazing team that makes Arizonans thrive? At the Arizona Department of Economic Security (DES) we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals who are committed to service, community, and teamwork. To learn more about DES please visit des.az.gov or click on the link here to view ‘Our DES’ video.

Come Join the DES Team! The parameter Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Nurse Manager. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community.

• Oversight, management, and performance of the utilization management program for the THP and subcontracted health plans, including deliverables and Operational Reviews (OR). Includes support of all health care services, including District Nurses and the Management Team regarding UM principles and oversight. Act as a liaison with other department staff and functions. Monitor UM activities of clinical and non-clinical staff.
• Participate/lead UM/MM related meetings with the Division, health plans, AHretrieve
  
  CS, as appropriate. Prepare and submit UM/MM standards and बनाए OR deliverables to Division Leadership and AHCCCS. Prepare/review/interpret statistical and narrative reports on utilization patterns, expenditures, demographics of service delivery and programs. Work in coordination with the CMO data team and other data teams.
• Review and update policy and procedures relating to MM/UM. Periodically assess the review process, criteria, and norms, and recommend any necessary changes. May access and consult with peer clinical reviewers, Medical Directors, and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost-effective care throughout the medical management process. Participates in CES reviews.
• Monitor, oversee, and conduct inpatient, concurrent, retrospective, out-of-network, and appropriateness of treatment and treatment setting review within the scope of licensure, utilizing appropriate clinical policies and guidelines, eligibility benefits, and contracts, as indicated. Participates in NCQA related reporting, such as unplanned transition.
• Monitor with the goal to prevent complications emergencia members' hospital stays. Advocate for quality of care, quality of life, and shorter hospital stays as appropriate. Maintain and review accurate records of members' clinical information and related activity. Hold collaborative weekly discharge planning meetings for health plans and THP. Maintain good community relationships with hospitals, vendors, and providers for DDD members.
• Assists and supports the THP with hospital discharge, durable medical equipment, and other clinical needs. Assists and supports prior authorization needs for members related to durable medical equipment and other clinical needs.
• Follows all members with transplant-related needs and serves as the transplant coordinator.
• Monitor, oversee, and conduct second-level reviews for contract and policy defined services and equipment. Performs and oversees the PASRR process for Division members.

Knowledge In:

• Utilization Management өл
• Microsoft Office and Google programs and spreadsheets.
• Admittance, discharge and billing procedures.
• Principles of nursing administration and management.
• Health assessment methods and techniques.
• Federal Regulations related to Medicaid, Medicare, Federal and State laws, agency rules, policies and procedures for medical services in a managed care environment.
• Arizona Health Care Cost Containment System (AHCCCS),…