Nurse Program Consultant

State of Maryland•Baltimore City, MD

18h•Hybrid

About The Position

The Nursing Program Consultant/Administrator I serves as the departmental clinical expert within a multidisciplinary grievance unit charged with collecting, handling, and tracking grievances for all Medicaid beneficiaries receiving home and community based services. This position is responsible for the management and oversight of a comprehensive grievance system that ensures accurate and timely tracking, assignment, and resolution of grievances. The Nursing Program Consultant/Administrator I will assist in creating the grievance system, facilitate collaboration across programs, collect and analyze grievance data, and ensure decisions on grievances are not made by anyone previously involved in the review or decision-making related to the grievance. The position involves developing and implementing written policies and procedures that meet the minimum requirements for the federal mandate. The position may require consulting with public and private agencies on grievance processes. A core function of this role is providing oversight of the grievance process to ensure compliance with all federal availability and accessibility requirements which include providing assistance to Medicaid beneficiaries with disabilities and Limited English Proficiency (LEP) in completing required forms and procedural steps to submit a grievance. This position will facilitate communication, maintain impartiality, and engage qualified individuals for grievance reviews. The Nursing Program Consultant/Administrator I ensures beneficiaries are informed of their rights and that grievances are addressed in compliance with established policies. This position will ensure that punitive or retaliatory action is neither threatened nor taken against an individual filing a grievance or who has had a grievance filed on their behalf. The Nursing Program Consultant/Administrator I will review any grievance resolution with which the beneficiary is dissatisfied. Additionally, the role involves collaborating with internal and external stakeholders, including clinical staff, to provide necessary input to ensure a robust and effective grievance resolution process. This position operates in a hybrid manner, meaning job duties will be performed both remotely and on-site unless otherwise directed by the appointing authority.

Requirements

A Master's degree in Nursing or a health-related field from an accredited college or university.
Five years of experience as a Registered Nurse.
One year of experience in an administrative, supervisory, consultative or teaching capacity.
A current license as a Registered Nurse from the Maryland State Board of Nursing, or possess a current multi-state license in party states that candidates have declared as primary states of residence.
Candidates may substitute the possession of a Bachelor’s degree in Nursing or health-related field from an accredited college or university and two years of experience as a Registered Nurse in an administrative, supervisory, consultative or teaching capacity for the required education.
Candidates may substitute the possession of a Doctorate degree in Nursing from an accredited college or university for two years of the required experience.
Candidates may substitute U.S. Armed Forces military service experience at a rank of Corporal/Petty Officer or higher as a commissioned officer in Nursing classification or Nursing specialty codes in the Nursing field of work on a year-for-year basis for the required experience and education.

Nice To Haves

Experience reviewing medical documentation.
Experience triaging escalated constituent/client concerns (grievances).
Experience working as part of a multidisciplinary team/unit to ensure appropriate resolution.
Experience working with or familiarity with the Maryland Medicaid Home and Community-Based Waiver and State Plan programs.
Experience developing and implementing standard operating procedures, policies and regulations.
Experience with data management systems for the purposes of tracking, trending, monitoring, and presenting recommendations to leadership.
Experience working with various stakeholders and be able to participate in stakeholder engagements appropriately and professionally.
Possess a motor vehicle operator's license valid in the State of Maryland.

Responsibilities

Serve as the departmental clinical expert within a multidisciplinary grievance unit.
Manage and oversee a comprehensive grievance system for Medicaid beneficiaries receiving home and community based services.
Ensure accurate and timely tracking, assignment, and resolution of grievances.
Assist in creating the grievance system.
Facilitate collaboration across programs.
Collect and analyze grievance data.
Ensure decisions on grievances are not made by anyone previously involved in the review or decision-making related to the grievance.
Develop and implement written policies and procedures that meet federal mandate requirements.
Consult with public and private agencies on grievance processes.
Provide oversight of the grievance process to ensure compliance with federal availability and accessibility requirements.
Provide assistance to Medicaid beneficiaries with disabilities and Limited English Proficiency (LEP) in completing required forms and procedural steps to submit a grievance.
Facilitate communication, maintain impartiality, and engage qualified individuals for grievance reviews.
Ensure beneficiaries are informed of their rights and that grievances are addressed in compliance with established policies.
Ensure that punitive or retaliatory action is neither threatened nor taken against an individual filing a grievance or who has had a grievance filed on their behalf.
Review any grievance resolution with which the beneficiary is dissatisfied.
Collaborate with internal and external stakeholders, including clinical staff, to provide necessary input to ensure a robust and effective grievance resolution process.