Hybrid Quality Management Nursing Consultant

State of Arizona; Phoenix (AZ); Hybrid; USD 60,000 - 82,000; Full time

Job summary

AHCCCS, Arizona’s Medicaid agency, seeks a Quality Management Nursing Consultant to assess and monitor service delivery, review provider resources, and ensure compliance with state and federal regulations. The role combines independent clinical judgment with collaboration across teams.

The position is hybrid, involves on-site investigations at least 20% of the time, and offers meaningful opportunities to address systemic issues and improve member care within AHCCCS guidelines.

Qualifications

• Knowledge of state and federal policies governing Medicaid and managed care.
• Clinical nursing knowledge and judgment.
• Utilization review and case management expertise.

Responsibilities

• Monitor compliance with state and federal regulations; track and resolve quality and safety issues.
• Provide clinical input for quality reviews and policy compliance.
• Conduct on-site investigations of health and safety concerns.
• Ensure quality of care and respect for member dignity.
• Lead process improvements and special projects with timely updates to management.
• Develop population-specific outcome metrics and analyze member data.
• Educate internal/external stakeholders on covered services and policy requirements.

Skills

Quality management

Clinical assessment

Utilization review

Policy knowledge

Case management

Education

Bachelor's in Nursing

Job description

AHCCCS, Arizona’s Medicaid agency, seeks a Quality Management Nursing Consultant to assess and monitor service delivery, review provider resources, and ensure compliance with state and federal regulations. The role combines independent clinical judgment with collaboration across teams.

The position is hybrid, involves on-site investigations at least 20% of the time, and offers meaningful opportunities to address systemic issues and improve member care within AHCCCS guidelines.