Salary : $91,704.00 - $150,264.00 Annually
Location : Thurston County - Olympia, WA
Job Type: Full Time - Permanent
Remote Employment: Remote Optional
Job Number:Department: Health Care Authority
Division: CQCT
Opening Date: 11/09/2026
Closing Date: 11/22/2026 11:59 PM Pacific
Salary Information: The high end of the salary range, Step M is typically a longevity step
DescriptionOccupational Nurse Consultant (Nurse Informaticist)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.
The OpportunityHelp 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.
Key Responsibilities Include:- 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 a 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 rulemaking.
- 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 data related to prior authorization, supporting needed reports and any next steps.
- Represent Medicaid in inter and intra agency initiatives, including continuous quality improvement initiatives, revisions to delivery of care models, litigation negotiations.
Why You'll Love This Role:- Your nursing expertise will have statewide reach, helping Apple Health clients get timely access to the care they need.
- You'll be at the forefront of health care interoperability, helping Washington put national data standards like FHIR into everyday practice.
- You'll reduce administrative burden on clinicians across the state, freeing more of their time for patient care.
- You'll work remotely with flexible scheduling options, as part of a clinical team that values innovation and evidence-based practice.
What You Bring:You are a curious, systems-minded nurse who is as comfortable reviewing a complex medical record as you are talking through data standards with a technical team. You make sound, independent clinical decisions and explain your reasoning clearly, whether in a provider letter, a leadership briefing, or a hearing. You build bridges between clinicians, technologists, and policy staff, translating each group's needs so the work can move forward. You stay current on emerging regulations and technology and enjoy sharing what you know with others.
Required Qualifications Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter, resume, and application.
- An active, unrestricted Washington State Registered Nurse license or Multi-State License.
- Interoperability & Health Information Technology (HIT)
- API & Data Standards Expertise: Technical understanding of Application Programming Interfaces (APIs), HL7, and Fast Healthcare Interoperability Resources (FHIR) standards, specifically as they apply to patient access, provider directories, and prior authorization.
- Electronic Health Record (EHR) Integration: Demonstrated ability to align complex provider EHRs and practice management systems with state payer databases.
- Workflow Automation: Demonstrated ability to design and implement standard, nonproprietary open workflows that automate data collection and reduce administrative burdens for clinicians.
- Regulatory Compliance & Policy Leadership
- Legislative Interpretation: Demonstrated mastery in interpreting and operationalizing federal Centers for Medicare & Medicaid Services (CMS) rulemaking and state regulations, specifically Washington Administrative Codes (WACs).
- Policy Formulation: Demonstrated ability to advise executive leadership, Medical Directors, and/or division heads on the financial and clinical utilization impacts of new or modified health care regulations.
- Advanced Utilization Review & Clinical Evaluation
- Evidence-Based Medical Necessity: Demonstrated competency in independently evaluating complex medical records against scientific evidence to make highly defensible prior authorization and claim payment determinations.
- Administrative Hearing Defense: Demonstrated skills in preparing organizational position statements, drafting legal declarations, and delivering expert clinical testimony during formal appeals and utilization review denial hearings.
- System Leadership & Change Management
- Cross-Functional Liaison: Demonstrated ability to serve as a high-level intermediary bridging the technical and clinical communication gaps between agencies, commercial payers, and community health care providers.
- Contract & Resource Management
- Contract Monitoring: Demonstrated ability to successfully negotiate, structure, and monitor health care and technology vendor contracts to ensure agency alignment.
- Clinical Education & Mentorship
- Subject Matter Expertise: Demonstrated ability to serve as the definitive, accessible clinical resource for all internal and external inquiries regarding assigned Medicaid clinical programs.
Required Competencies: Equity lens - All HCA employees are required to consider equity in their decisions, processes, and day-to-day work, including how their work may affect the people and communities we serve.
The ability to take action to learn and grow - You take action to learn and grow by seeking new perspectives, learning from experiences, and using what you've learned to continuously improve how you work and serve others.
The ability to take action to meet the needs of others - You take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve.
Preferred QualificationsWhile these are not required, having them may help you stand out as an applicant.
- National Coding Systems: Demonstrated proficiency in translating annual and quarterly CPT and HCPCS codes into active Medicaid policies, provider guides, and billing systems.
- Continuous Quality Improvement (CQI): Demonstrated mastery in reviewing prior authorization and API metrics data to identify systemic gaps, generate federal reports, and lead intra-agency care delivery updates.
- Alternative Care Negotiation: Demonstrated ability to consult with community providers to propose and negotiate alternative, covered, and more cost-effective treatment pathways that still meet the patient's clinical needs.
- A master's degree in nursing (MSN or MN), business administration (MBA), or health administration (MHA).
- Certification in informatics (RN-BC in Informatics or CPHIMS).
- Knowledge of HCA structure, systems, communication methods, and forms.
Work Location and Schedule: This is a full-time 40-hour-per-week remote position. Our standard business hours are Monday through Friday, 8 a.m. to 5 p.m., with alternative work schedules considered based on business needs and supervisor approval. In this role you will regularly collaborate with colleagues, agency leaders, state and federal partners, and other external partners or customers. Occasional travel may be required for meetings, training, or other business needs. All employees are required to report to our Olympia office on their first and final day of employment.
