Remote Clinical Nurse Informaticist: Interop Lead

State-of-Washingto; Olympia (WA); Remote; USD 110.000 - 170.000; Vollzeit

Zusammenfassung

HCA's Clinical Quality and Care Transformation division seeks a Clinical Nurse Specialist with nurse informatics expertise to lead the implementation of state and federal prior authorization interoperability requirements, including HB 1357 and CMS-0057-F.

You will shape systems, workflows, and policies to make prior authorization decisions more efficient while ensuring Apple Health clients receive medically necessary, high-quality care. The role is remote with occasional in-person meetings.

Qualifikationen

• Must hold nursing license and clinical expertise in informatics.

Aufgaben

• Lead information exchange components for prior authorization and API.
• Coordinate with divisions, payers, and EHR systems on documentation.
• Configure Medicaid policies in payment systems and serve as subject matter expert.
• Represent Washington State Medicaid in CMS rulemaking and WEDI.
• Conduct utilization reviews and determine pre-authorization and claim payments.
• Review reconsideration requests and provide declarations/testimony.
• Apply CPT/HCPCS code updates to policies and notices.
• Analyze API metrics for reporting and advise on policy impacts.
• Negotiate contracts and liaise with DSHS and health departments.

Kenntnisse

Nurse informatics

Clinical decision making

Systems-minded

Data standards (FHIR)

Policy interpretation

Jobbeschreibung

HCA's Clinical Quality and Care Transformation division seeks a Clinical Nurse Specialist with nurse informatics expertise to lead the implementation of state and federal prior authorization interoperability requirements, including HB 1357 and CMS-0057-F.

You will shape systems, workflows, and policies to make prior authorization decisions more efficient while ensuring Apple Health clients receive medically necessary, high-quality care. The role is remote with occasional in-person meetings.