<strong>Salary :</strong> $89,904.00 - $147,312.00 Annually<br><strong>Location :</strong> Thurston County - Olympia, WA<br><strong>Job Type:</strong> Full Time - Permanent<br><strong>Remote Employment:</strong> Remote Optional<br><strong>Job Number:</strong> 2025-04588<br><strong>Department:</strong> Health Care Authority<br><strong>Division:</strong> CQCT<br><strong>Opening Date:</strong> 07/02/2025<br><strong>Closing Date:</strong> 7/7/2025 11:59 PM Pacific<br> <br><strong>Description</strong><br><strong>Occupational Nurse Consultant (ONC/CQCT)</strong><br><br><strong>71100442</strong><br>All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.<br><strong>About the division:</strong><br><br>The division of Clinical Quality and Care Transformation (CQCT) makes clinical policy decisions to guide health care coverage, to maintain quality standards, ensure evidence-based practices for our clients' healthcare, and to support statewide care transformation.<br><strong>About the position:</strong><br><br>This Occupational Nurse Consultant (ONC) is responsible for implementing and managing statewide clinical programs and policies related to durable medical equipment. This position effectively manages these clinical programs, including implementing policies and applying best practices principles in utilization management and quality of care standards that contribute to over $2 billion in federal and state Medicaid Title XIX, Titles XXI and state funds. In addition, this position applies utilization review principles, as well as evidence-based WAC criteria, the principles of WAC 182-501-0165, and makes evidence based medical necessity determinations for client specific medical services which require prior authorization.<br><strong>This position is eligible to telework and is typically not required to report on-site more than one (1) day a month. Occasional travel is required for work-related meetings, trainings, and contract monitoring. </strong>The default assigned work location of all Health Care Authority (HCA) positions - both on-site and telework eligible positions - is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. <strong>HCA has currently suspended the ability to support out-of-state telework.</strong> <br><br> <strong>Duties</strong><br><strong>Some of what you will do:</strong><br><ul><li>Serve as clinical program manager for assigned programs, implementing program goals and objectives. Developing and implementing policy and procedures, clinical criteria, WAC, billing instructions and other relevant utilization management and quality assurance activities.</li><li>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.</li><li>Work with staff to identify opportunities for education of HCA staff and community health care professionals to support program success.</li><li>Represents Medicaid in inter and intra agency initiatives, including continuous quality improvement initiatives, revisions to delivery of care models, litigation negotiations.</li><li>Advises manager, Medical Director, division directors and executive leadership of need for new regulations, formulating policy, or modifying existing policy /regulation using data to support position, including cost and utilization implications.</li><li>Make referrals to other department units and divisions or other state agencies, including Quality Management Team, Medical/Hospital Audit or Department of Health, as indicated.</li><li>Provide consultative services to community health care professionals, offering and negotiating covered, less costly treatment options in lieu of the requested services to assure each client's needs are met.</li><li>Apply clinical knowledge and skills in evaluating client health care documentation and data in medical records.</li><li>Make independent clinical decisions about the adequacy, appropriateness, and conformance with accepted standards of care, of services proposed by health care providers to make an authorization determination.</li><li>Negotiate and monitor contracts.</li><li>Perform liaison activities with other HCA and DSHS divisions, the Department of Health, Department of Corrections, federal agencies, and provider groups using clinical knowledge and expertise.</li></ul><br> <strong>Qualifications</strong><br><strong>Required qualifications:</strong><br>Qualifying candidates will meet <strong>one</strong> of the following criteria options:<br>Option 1: <br><ul><li>A master's degree in nursing.</li><li>An active, unrestricted Washington State Registered Nurse license or Multi-State License.</li><li>Two (2) years of clinical or functional nursing experience.</li><li>Two (2) years of related administrative, consultative, utilization or case management experience.</li></ul><br>Option 2:<br><ul><li>A bachelor's degree in nursing.</li><li>An active, unrestricted Washington State Registered Nurse license or Multi-State License.</li><li>Three (3) years of clinical or functional nursing experience.</li><li>Two (2) years of related administrative, consultative, utilization or case management experience.</li></ul><br>Option 3: <br><ul><li>An active, unrestricted Washington State Registered Nurse license or Multi-State License.</li><li>Seven (7) years of clinical or functional nursing experience</li><li>Two (2) years of related administrative, consultative, utilization or case management experience.</li></ul><br><strong>Preferred qualifications:</strong><br><br><ul><li>Bachelor of Science Degree in Nursing or Bachelor's in closely allied field.</li><li>Knowledge of HCA structure, systems, communication methods, and forms.</li><li>Strong leadership, communication and program management skills; including the ability to work across boundaries, work both independently and collaboratively, and meet deadlines.</li><li>Experience writing Medicaid State Plan Amendments, Washington Administrative Code, Medicaid Provider Guides, and technical reports.</li><li>Ability to manage multiple activities, establish priorities, and advance assigned projects from inception to completion with limited supervision.</li><li>Provider One experience.</li><li>Working knowledge of the Affordable Care Act (ACA) and Medicaid rules and regulations.</li><li>Knowledge of coding principles/rules for ICD-10.</li></ul><br><strong>How to apply:</strong><br>Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. <strong>To apply for this position, you will need to complete your profile which includes three professional references and attach:</strong><br><ul><li>A <strong>cover letter</strong> that specifically addresses how you meet the qualifications for this position.</li><li>Current <strong>resume</strong>.</li></ul><br>To take advantage of <strong>veteran preference</strong>, please do the following:<br><ul><li>Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter. </li><li>Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov. </li></ul><br> <strong>Supplemental Information</strong><br><strong>About HCA: </strong><br><br>Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.<br><br>There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents. <br><strong>What we have to offer:</strong><br><ul><li>Meaningful work with friendly co-workers who care about those we serve Voices of HCA </li><li>A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values</li><li>A healthy work/life balance, including alternative/flexible schedules and mobile work options.</li><li>A great total compensation and benefit package WA State Government Benefits</li><li>A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby. </li><li>Tuition reimbursement</li><li>And free parking! </li></ul><br><strong>Notes:</strong><br><br>Please note, salary is based on experience and is determined at the time a final offer of employment is made. Per State HR guidance, nursing salaries are considered a "special pay range" and details on that range can be found here: The salary range listed in the job posting includes steps A-U. Step U is a longevity step and is typically gained six years into being assigned step T in your permanent salary range.<br><br>Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.<br><br>HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA's mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Leila Vandiver at 360-725-5130 or leila.vandiver@hca.wa.gov.<br>The Washington State Health Care Authority (HCA) is an . All applicants with a in the United States are encouraged to apply.<br>E-Verify® is a registered trademark of the U.S. Department of Homeland Security.<br>to receive a list of new job postings at HCA.<br><strong>More than Just a Paycheck!</strong><br>Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.<br><br>We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. That's why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.<br><br><strong>Read about our benefits:</strong><br>The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.<br><br><strong>Note:</strong> If the position offers benefits which differ from the following, the job posting should include the specific benefits. <br><br><strong>Insurance Benefits</strong><br>Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.<br><br>Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.<br><br>To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.<br><br>Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.<br><br>Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.<br><br>The Washington State Employee Assistance Program promotes the health and well-being of employees.<br><br><strong>Retirement and Deferred Compensation</strong><br>State Employees are members of the Washington Public Employees' Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems' web site.<br><br>Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.<br><br><strong>Social Security</strong><br>All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.<br><br><strong>Public Service Loan Forgiveness</strong><br>If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.<br><br><strong>Holidays </strong><br>Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.<br><br><strong>Note:</strong> Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.<br><br>Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday. <br><br>Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.<br><br><strong>Sick Leave </strong><br>Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave. <br><br>Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.<br><br><strong>Vacation (Annual Leave)</strong><br>Full-time employees accrue vacation leave at the rates specified in (1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.<br><br>Part-time employees accrue vacation leave hours in accordance with (1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.<br><br>Pay status includes hours worked, time on paid leave and paid holiday.<br><br>As provided in , an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165. <br><br><strong>Note:</strong> Most agencies follow the civil service rules covering leave and holidays for <strong>exempt </strong>employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.<br><br><strong>Military Leave</strong><br>Washington State supports members of the armed forces with 21 days paid military leave per year.<br><br><strong>Bereavement Leave </strong><br>Most employees whose family member or household member dies, are entitled to three (3) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.<br><br><strong>Additional Leave</strong><br>Leave Sharing<br><br>Family and Medical Leave Act (FMLA)<br>Leave Without Pay<br><br>Please visit the State HR Website for more detailed information regarding benefits.<br><br>Updated 12-31-2022<br>01 <br> <br> I acknowledge that this opportunity will require some travel. <ul> <li>Yes</li> <li>No</li> </ul> <br>02 <br> <br> Do you currently have an active, unrestricted Washington State Registered Nurse license or Multi-State License? <ul> <li>Yes</li> <li>No</li> </ul> <br>03 <br> <br> Please select the highest level of education that you have completed: <ul> <li>High school graduation or equivalent</li> <li>Associate degree</li> <li>Bachelor's degree</li> <li>Master's degree or higher</li> <li>None of the above</li> </ul> <br>04 <br> <br> Which of the following best describes your professional experience with clinical or functional nursing? <ul> <li>I do not have this experience.</li> <li>Less than 1 year</li> <li>More than 1 year, but less than 3 years</li> <li>More than 3 years, but less than 5 years</li> <li>More than 5 years, but less than 7 years</li> <li>7 years or more of this experience</li> </ul> <br>05 <br> <br> Which of the following best describes your professional experience with nursing related administrative, consultative, or case management? <ul> <li>I do not have this experience.</li> <li>Less than 1 year</li> <li>More than 1 year, but less than 3 years</li> <li>More than 3 years, but less than 5 years</li> <li>More than 5 years, but less than 7 years</li> <li>7 or more years of this experience</li> </ul> <br>06 <br> <br> If hired for this position, do you currently possess required documents to allow you to legally work within the United States? The attached link lists acceptable documents: https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents <ul> <li>Yes</li> <li>No</li> </ul> <br>07 <br> <br> Will you now or in the future require sponsorship for an immigration-related employment benefit?For purposes of this question "sponsorship for an immigration-related employment benefit" means "an H-1B visa petition, an O-1 visa petition, an E-3 visa petition, TN status and 'job flexibility benefits' (also known as I-140 portability or Adjustment of Status portability) for long-delayed adjustment of status applications that have been pending for 180 days or longer." (Please contact us at the email address on the bottom of this job posting if you are uncertain whether you may need immigration sponsorship or desire clarification.) <ul> <li>Yes</li> <li>No</li> </ul> <br>08 <br> <br> I acknowledge that I have included at least three references, and that I have uploaded a cover letter and resume in the attachments section of my application. <ul> <li>Yes</li> <li>No</li> </ul> <br>Required Question
