The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a EPSDT/Maternal Child Health Care Coordinator. After extensive training, this position has the potential of being worked from home with some in office meetings. Under the leadership of the Managed Care Program Administrator, this position provides oversight of the Early and Periodic Screening Diagnosis and Treatment (EPSDT), Preventive Health, Family Planning, Special Needs Populations and Maternal Health programs within the statewide managed care and fee for-service AHCCCS programs. This position will provide leadership and support to ensure the development of a fully integrated Clinical Quality Management Unit within the Division of Health Care Management. Major duties and responsibilities include but are not limited to:
• Monitoring of EPSDT, well woman preventive health, maternity, and family planning programs to ensure that state and federal requirements are met.
• Participates in operation reviews, administrative reviews, technical assistance, and focused studies/reviews to ensure compliance with contractual and policy requirements for all lines of business.
• Represents the CQM Unit in developing and providing input to contracts, amendments and policy revisions.
• Provides technical assistance to Contractors and FFS providers, as appropriate regarding contractual and/or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements to improve EPSDT and maternal child health services to AHCCCS Members.
• Collaborates with state and local health and social service agencies, including ADHS, DES/DDD, DCS, Head Start, etc. as well as community and private health care providers.
• Coordinates and completes tracking, evaluations, and responses to Contractor deliverables.
• State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, LTC and Tribal lines of business.
• Knowledge of medical/nursing practice, medical case management protocols, quality management and utilization review protocols as related to the all populations including maternal and child health services, well woman preventive health, family planning services, EPSDT, acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, behavioral/mental health, children in the foster care system and Tribal lines of business.
• Current quality improvement and health care theories and practices.
• Background in and knowledge of quality management principles and accreditation bodies' review processes.
• Organizational skills that result in prioritization of multiple tasks including project management to meet goals and deadlines.
• Effective communication with all levels of professionals, corporate and agency officers and members.
• Develop, implement, and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, Sister Agency and/or tribal Contractors.
• Certified Professional in Healthcare Quality
• Current Arizona nurses license
• Baccalaureate degree in nursing (preferred)
• At least one year experience working in a managed care environment
In accordance with CFR §432.50 FFP, skilled professional medical personnel must have professional education and training in the field of medical care or appropriate medical practice. "Professional education and training" means the completion of a 2-year or longer program leading to an academic degree or certification in a medically related profession. For this position, a licensed Registered Nurse, Physician's Assistant, Nurse's Practitioner is required. Experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in a field of medical care.
At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
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.
Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.