The Division of Fee for Service Management is looking for a highly motivated individual to join our team as a Serious Mental Illness Behavioral Health Prior Authorization/Utilization Review Manager. This position works under the direction of the Clinical Administrator. This position is responsible for management and oversight of the DFSM Behavioral Health Prior Authorization/Utilization Review (BH PA/UR) staff and unit processes. Duties include working with Providers, resolution or Provider issues and BH PA/UR reporting. The position provides monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for the members’ physical/acute care services and behavioral health needs.
Major duties and responsibilities include but are not limited to:
● Provides direct management of the DFSM Behavioral Prior Authorization/Utilization Review (BH PA/UR) unit, including supervision of the BH PA/UR nurses and other staff. Oversees and directs the technological aspects of the BH PA/UR process and maintains reporting structure and processes.
● Works in conjunction with the CMSU Team and other AHCCCS divisions and units, groups and external partners as required on policies and procedures related to behavioral health care services such as SMI determinations, special assistance, seclusion, and restraint, access to care and out of state placement request.
● Oversees and directs interaction with Fee-for-Service Providers, including Provider issues resolution and technical assistance.
● As needed, provides backup for the responsibilities held by the BH Prior Authorization/Utilization Review unit and other CMSU functions as needed.
● As a subject matter expert, assist in the development of policies and procedures as required for delivery of covered behavioral health services.
● Knowledge of Principles and practice of management and supervision, of data research and report development.
● Knowledge of Information technology processes and potential prior authorization processes, health care delivery systems and mechanisms for coordination and delivery of services.
● Knowledge of Principles of behavioral and/or medical nursing management and assessment, current standards of medical/behavioral practice and modes of delivery for acute and non-acute medical/behavioral health care and services.
● Knowledge of Current costs, appropriateness and utilization of medical supplies and equipment.
● Knowledge of Principles of utilization review, alternative levels of care, ICD, CPT and DSM coding and medical billing guidelines.
● General knowledge of behavioral health service delivery system and the needs of individuals designated as SMI.
● Skills in Problem solving identification, evaluation, and imitation of appropriate action, nursing, and case management assessment.
● Excellent verbal/written communication skills, with FFS Providers.
● Organizational skills to coordinate, monitor and report on multiple cases simultaneously.
● Analytical skills to identify and correlate specific patterns, initiate investigate investigations, submit findings and recommendations.
● Strong interpersonal skills in working with people of diverse cultures and socio-economic backgrounds.
● Strong ability to collaborate with others for mutually beneficial outcomes.
● Ability to read, interpret, and apply complex rules and regulations.
● Ability to Independently make decisions yet knowing when to elevate the decision.
● Ability to drive long distances when required.
● Licensed Registered Nurse, Physician’s Assistant or an Advanced Practice Registered Nurse is required.
● Four years professional experience related to health programs appropriate to assignment, which includes program planning or administration: a master’s degree in a field appropriate to the assignment may substitute for one year of the required experience.
● Prior supervisory or managerial experience.
● Experience with the Court Order Evaluations (COE) Court Ordered Treatment (COT) processes, the Serious Mental Illness (SMI) determination process, understanding of non-title funding, and experience with the tribal healthcare delivery system.
• 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 then 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.