The Division of Fee for Service Management is looking for a highly motivated individual to join our team as a Clinical Care Specialist. This position is under the direction of CMSU PA/UR Manager, this position is responsible for processes and projects related to the care management PA/UR efforts for FFS/SMI members. This position will work closely with CMSU staff. Including care management and care coordination support functions, such as monitoring, processing, and distribution of care management referrals, outreach, documentation and follow up as directed.
Major duties and responsibilities include but are not limited to:
● Provide support to the CMSU PA/UR team functions, including researching provider claims and Prior Authorization inquiries, monitoring, processing, and distribution of prior authorizations, makes referrals as necessary, assist with provider or member outreach, documentation and follow up as directed.
● Serve as the lead for care management projects, including the research, development and maintenance of PA/UR care management resources, processes, and desk levels.
● Respond to provider inquires, including technical assistance in the areas of prior authorization, denials, reconsiderations and other CMSU processes.
● Outreach IHS and non-IHS/638 facilities to establish and maintain facility contact and resource data.
● Cross-train as back up to other CMSU learn functions: serve as backup for implementation of COOP protocols and processes, tracking and reporting of CMSU care management data.
● Healthcare Delivery Systems. Familiarity with Native American Tribes/programs.
● Knowledge of ICD and HCPC codes.
● Familiarity of authorization and utilization review.
● Specific geography of Arizona and New Mexico and surrounding states.
● Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations.
● Organizational skills to coordinate, monitor and report.
● Strong interpersonal skills in working with people of diverse cultures and socio-economic backgrounds.
● Intermediate computer skills (i.e. Microsoft Office Suite, Word, Excel, and Google).
● Strong ability to collaborate with others for mutually beneficial outcome.
● Plan, organize, prioritize work, and multitask in a fast-paced environment.
● Understand clinical information, ability to read, interpret, and apply complex rules and regulations.
● Drive long distances when required.
● Two years of experience in a healthcare support role.
● Experience in prior authorization review, prior experience working with Tribal entities.
• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
• Travel is required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension, or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
Among the many benefits of a career with the State of Arizona, there are:
• 10 paid holidays per year
• Paid Vacation and Sick time off (12 and 13 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities
• Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing email@example.com.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.
ARIZONA MANAGEMENT SYSTEM (AMS)
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.
State employees are highly engaged, collaborative and embrace a culture of public service.
The State of Arizona is an Equal Employment Opportunity Employer.