Occupational Nurse Consultant; ONC​/CQCT

This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs.

All HCA employees are required to be Washington state residents upon their first day of employment.

Help shape how Washington Medicaid connects clinical care and technology. The Clinical Quality and Care Transformation (CQCT) division is seeking a Nurse Informaticist to lead HCA's implementation of state and federal prior authorization interoperability requirements, including HB 1357 (as amended by HB 1706) and CMS-0057-F. You will apply your clinical judgment and informatics knowledge to design and refine the systems, workflows, and policies that make prior authorization decisions more efficient, while ensuring Apple Health clients receive medically necessary, high-quality care.

• Lead oversight and implementation of the information exchange components of state and federal legislation regarding prior authorization and Application Programming Interface (API) for HCA and Medicaid.
• Support information gathering and coordination as needed for HCA/Medicaid to identify prior authorization information and documentation requirements and facilitate exchange of prior authorization requests and determinations between provider electronic health record EHR)/practice management systems and relevant payers.
• Support development of standard and automated approaches using nonproprietary open workflows to compile and exchange the necessary data elements to populate prior authorization requirements.
• Engage CQCT team members, project team members, and applicable divisions to understand current state of prior authorization workflows; provide guidance for configuration of new and existing Medicaid clinical policies into payment systems.
• Coordinate informatics resources and clinical information system initiatives related to HCA divisions and external EHR systems.
• Facilitate and optimize informatics processes, enhance coordination, training, support processes and provide overall direction for clinical informatics requiring the use of leadership and decision- making abilities.
• Facilitate processes that improve efficiency, reduce team/ clinician burden, and enhance patient care.
• Serve as a liaison between HCA, providers, payers, and the community regarding clinical information system initiatives.
• Participate in forums such as the Workgroup for Electronic Data Interchange ( WEDI).
• Serve as subject matter expert for matters related to prior authorization interoperability and other interoperability initiatives including but not limited to provider directory, patient access, and other APIs, and integration into current and new HCA initiatives.
• Provide WA state Medicaid agency perspective in CMS rule making.
• Collaborate with HCA management and staff in the formulation of statewide policy and clinical standards that ensure the delivery of quality care is rendered and services are appropriately utilized.
• Work with staff to identify opportunities for education of HCA staff and community health care professionals to support program success.
• Serve as clinical resource and subject matter expert to both internal and external stakeholders for all clinical issues/ questions related to assigned programs. Responsible for interpretation of applicable WACs and assures adherence to department rules and policy.
• Determine application of the yearly and quarterly national CPT and HCPCS codes including updating relevant policies and provider communications including provider notices and provider guide.
• Participate in required state or federal reporting for prior authorization or API metrics. Review and evaluate…