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GRIEVANCE APPEALS OFFICE MANAGER

  • 501225
  • PHOENIX
  • DEPT OF ECONOMIC SECURITY
  • Full-time
  • Closing date: Sep 22 2021 at 23:55 MST

DEPARTMENT OF ECONOMIC SECURITY

Your Partner For A Stronger Arizona.

DES works with families, community organizations, advocates and state and federal partners to realize our collective vision that every child, adult, and family in Arizona will be safe and economically secure.

DES serves more than 3 million Arizonans Our Mission is to make Arizona stronger by helping Arizonans reach their full potential through temporary assistance for those in need, and care for the vulnerable.

GRIEVANCE APPEALS OFFICE MANAGER

Division of Developmental Disabilities (DDD)

Job Location:

Address:  4000 North Central Avenue, Phoenix, Arizona 85012

Posting Details:

Salary: $65,544.75 - $84,157.00 

Grade: 23

Closing Date:  September 22, 2021 

Job Summary:

Would you like to be part of an amazing culture that helps Arizonans reach their full potential through providing services to support them? The Arizona Department of Economic Security (DES) is looking for individuals that are committed to service, community, and teamwork.

The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Grievance Appeals Office Manager. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community. This position is responsible for:

Job Duties:

• This position oversees the Public Records Unit and the administration of the Office of Administrative Review (OAR) which oversees a Division-wide grievance, appeal, and fair hearing process for members, families, business associates, advocacy representatives, etc. with appropriate state agencies, such as the AZ Health Care Cost Containment System (AHCCCS) and AZ Dept. of Health Services (DHS), and federal and state entities, including federal and state courts. This position is responsible for representing the Division as an expert witness in the interpretation of federal and state regulations, rules, policies, and procedures for evidentiary hearings held at all levels. This is an AHCCCS Key Position for Grievance and Appeals.
• This position participates and directs staff to ensure compliance with program and regulatory provisions. This position coordinates communication of DDD legal activities across all departments within the Division. This position is accountable for monitoring of the fair hearing process coordinating between business units to ensure the adjudication process. This position is responsible for reviewing and approving proposed actions with the Contracts unit and Attorney General's Office.
• This individual shall collaborate with stakeholders to address provider or member SMI grievance and SMI appeal process concerns. This qualified individual shall collect necessary information, consult with the member’s treatment team and consult with the Contractor’s CMO or a care manager for clinical recommendations when applicable, develop communication strategies in accordance with confidentiality laws, and develop a written plan to address and resolve the concern, to be approved by AHCCCS prior to implementation.
• This position assumes the leadership role in the administration of records maintained by the Division. This position also oversees and directs handling of personnel matters, including hiring, supervision, performance evaluations, and discipline. Such responsibilities include the development, coordination, implementation, maintenance of, and adherence to all policies and procedures required to fulfill these responsibilities. An understanding of federal and state laws is required in order to carry out the primary purposes of this position.
• This position is responsible for the development and provision of AHCCCS/DDD contract deliverables and the operational reviews as required under the contract for the applicable sections under the key position. The position is also responsible for the review and approval of all deliverables provided by the subcontracted health plans as applicable under the purview of the key positions represented by this employee. The incumbent is also responsible for all the oversight activities including but not limited to operational reviews and targeted audits and ad hoc reports as deemed necessary to ensure proper oversight.
• This position conducts research and analysis and prepares written communications and recommendations, that apply certain facts and laws, for executive leadership.
• This position designs and develops Lean management and operations analysis systems and methods and activities, including the development of metrics, annual improvement plans and problem-solving activities. This position uses AMS principals to implement changes to statutes, administrative rules, policies and procedures. This position also can sponsor, direct and participate in IT projects and other major projects or initiatives as a subject matter expert.
• This is a Key Position as identified in the contract with AHCCCS and is responsible for duties and deliverables as described in the contract as well as special projects as may be assigned.

Knowledge, Skills & Abilities (KSAs):

• Knowledge of Department and Division programs and activities.
• Knowledge of Department of Economic Security (DES), Arizona Health Care Cost
Containment System (AHCCCS), Department of Administration, Department of Homeland
Security, and other State government agencies and state service policies, procedures, and
operations.
• Knowledge of Federal, state, and county laws and judicial systems.
• Knowledge of Statutes, rules, and regulations and their development and adoption.
• Knowledge of Insurance programs (health insurance, provider insurance, etc.).
• Knowledge of Management practices and procedures
Contracts management.
• Skills in Leadership in the development and implementation of administrative, technical,
and physical safeguards to protect the privacy of health information.
• Skills in Oral and written communication, including public speaking.
• Skills in Time management (e.g., planning, organizing, directing, controlling, etc.).
• Skills in Developing management and operational analysis of programs and activities.
• Ability in Analyze information and data involving appeals and claim disputes.
• Ability to Analyze, interpret, and understand how insurance rates are developed for acute
care and long term care services.
• Ability to Unite diverse groups with disparate interests in working as a team toward
common goals.
• Ability to Communicate diplomatically, clearly, and simply concerning complex issues with
diverse groups of people.
• Ability to Reason logically and deductively.

Selective Preference(s):

Graduation from an accredited law school & licensed to practice law in any state. Experience as a Hearing Officer, practicing administrative law, or representing parties before administrative tribunals. Prefer supervisor or manager experience. Experience with healthcare programs or managed care organizations serving individuals with DD. Experience in Medicaid Program Integrity.

Pre-Employment Requirements:

Travel may be 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 in accordance with DES Fleet Management­ Safety Program policy and procedures (DES 1-07-26 & DES 1-07-26-01.) 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.

In accordance with the Arizona Health Care Cost Containment System contract as defined in 42 CFR 455,104, SMDL #09-001) a search for the incumbent will be conducted monthly using the List of Excluded Individuals and Entities (LEIE) and the System for Award Management (SAM).

Benefits:

We offer a competitive benefits package that is unmatched by the private sector and a culture that encourages team success and advocates for personal advancement.
-Affordable Health, Dental, Vision and Life and Disability Insurance
-10 holidays per year
-Paid Vacation and Sick time off - start earning it your 1st day
-Eligible to participate in the Public Service Loan Forgiveness Program (must meet qualifications)
-Contribute to, and participate in the Arizona State Retirement System
-Ride Share and Public Transit Subsidy
-Career Advancement Opportunities
-Tuition reimbursement
-Opportunity to work remotely (home office) on an ad-hoc basis

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

State employees are required to participate in the Arizona State Retirement System (ASRS), the State sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.

Contact Us:

Apply through azstatejobs.azdoa.gov.

For questions about this career opportunity, please call Teresa Brown at (480) 673-0590 or email tbrown@azdes.gov. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 480-318-4150.
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.