The Division of Community Advocacy & Intergovernmental Relations (DCAIR) ensures Health Plan and Program Contractors’ resolution of consumer affairs and human rights issues and compliance with related aspects of their contracts. DCAIR is looking for a highly motivated individual to join our team as a Data & Policy Manager. Under the direct supervision of the Office of Human Rights (OHR) Bureau Chief, this position will be responsible for oversight of Contractor compliance with AHCCCS Policy, the Arizona Administrative Code, and contract by ensuring accurate and timely deliverables are submitted. The position will monitor Health Plan compliance and provide technical assistance to Contractors and Providers as needed. Major duties and responsibilities include but are not limited to:
• Responsible for daily monitoring and processing of new notifications in the AHCCCS QM Portal. Assisting the Bureau Chief with technical assistance training and support for contracted health plans and providers, including working with clinicians, Health Plans, guardians and natural supports to facilitate resolution of issues on behalf of SMI members. This may require state-wide travel as necessary.
• Monitor program performance to assure contract compliance regarding the contracted deliverables. Complete quality checks on special assistance data including verification of facility license type, accuracy of site assignment, contact information for clinical teams or if applicable person(s) meeting needs including review, accepting or rejecting deliverables. Deliverables specific to required special assistance demographic updates in accordance with AMPM 320-R. Responsible for preparing and hosting a monthly meeting with each health plan to review the QM Portal processing, grievances and appeals and discuss systemic issues and will result in outreach to train clinics/health homes after identifying issues.
• Interpret rules and regulations and provide technical assistance to Contractors, Providers and AHCCCS with policy revisions including but not limited to AMPM 320R, ACOM 444/446 and R9-21. Complete weekly/monthly activity reports and database entries in a timely manner to assist in tracking and trending contractor compliance measures. Develop program evaluation procedures and monitor contractor compliance as required by Arizona Administrative Code, Policy, & Contract.
• Responsible for OHR deliverables, including but limited to the following: Prepare/export portal demographics for all Special Assistance members and submit to the respective IOCs, TRBHAs, ASH. Responsible for preparing TRBHA quarterly reports and entering TRBHA updates into the QM Portal and monitor compliance of returned deliverables. Will be responsible to send the exported QM portal demographics of all Special Assistance members to the Patient Benefit Manager at the Arizona State Hospital for reconciliation.
• Generate and maintain comprehensive reports for all TRBHAs and manage and collaborate with Bureau Chief on ad-hoc deliverables for T/RBHA database clean up.
• Review, process and distribute the Closed Enrollment Report on a weekly basis to verify that all active records are linked to an open enrollment. Will also be responsible for exporting the PMMIS (Date of Death Report) to identify closures/Part Cs that need to be monitored for AMPM 302-R compliance.
• Monitor health plan compliance for all grievances and appeals and will elevate all non-compliance as necessary to ensure the formal SMI grievance and appeals process is available to the community and in compliance. Will monitor OHR state-wide for adhering to the AAC and AHCCCS policy to provide updates to the Bureau Chief. Will partner with AHCCCS compliance officers for ongoing follow up on compliance concerns. Will engage in the System Service Request (SSR) process to utilize the Requirements and Design (R&D) process to correct issues and make improvements to the portal functionality. This position will also serve as the Data steward for DCAIR/OHR.
• Basic structure and operation of the behavioral health system.
• Service and discharge planning processes; member rights.
• SMI grievance and administrative appeal processes; rules, statutes and regulations that define the standards of care applicable to the behavioral health system.
• Performance Management (PM) model and continuous quality improvement (CQI) methods in a public health setting.
• Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds and those in crisis.
• Communicate orally and in writing with members and their Health Care provider to facilitate resolution or presenting issues.
• Provide recommendations to the RBHA/MCO/provider for service delivery improvement.
• Conduct technical assistance via virtual platforms and in the field. Explain basic administrative rights & and processes in person and via virtual platforms.
• Bachelor's degree in behavioral health or related field and
• Two years of professional experience related to health programs.
• A Master's degree in a field appropriate to the assignment may substitute for one year of the required experience.
• Coursework in psychology, sociology, criminal justice, medical terminology, administrative law, alternative dispute resolution, substance abuse, addiction, co-occurring disorders, social work. or counseling.
• Experience in the delivery of service in Arizona's public behavioral health system.
• One-year experience in providing advocacy.
• 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 firstname.lastname@example.org.
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.