AHCCCS

Address:  801 E. Jefferson Street, Phoenix, AZ 85034

Salary: $250,000 - $264,000

Grade: 01

Open Until Filled

As Medical Director, this position is responsible for decisions related to medical care and day-to-day availability for consultation regarding services provided to the AHCCCS Managed care Acute Care, ALTCS, and special populations, as well as oversight of the care rendered to the AHCCCS population by various managed care organizations and providers. 

Major duties and responsibilities include but are not limited to:
• Makes decisions related to clinical care and is available for consultation regarding care and services rendered to the ACC, ACC-RBHA, CHP, ALTCS (EPD and DDD), and other special populations. Oversight of the care rendered to AHCCCS populations by managed care organizations. Provides guidance on AHCCCS Medical Policy Manual (AMPM) and program implementation. Provides updates to the Assistant Director as well as agency leadership upon request. Reviews clinical desk level (standard work) procedures.
• Works with DHCS Clinical staff and the Deputy Assistant Director for Managed Care Clinical Compliance to improve care transition planning and procedures for members. Provide clinical leadership/insight to the Quality Management (QM) team for complex case reviews. Leads peer reviews (to be established by the QM team). Coordinates with other clinical and operational teams as clinical questions and or need for guidance is identified.
• Works closely with the Office of General Counsel Services on the clinical issues that arise in the grievance and appeals process and participates in Administrative Hearings. Supports the SMI Grievance and Appeals team with complex clinical cases related to SMI rights and related care. Assists others in the agency in implementing the Health Information Exchange (HIE), designing the best uses for these tools for the benefit of members, development of policies related to new clinical technologies, telemedicine, and HIE Initiatives.
• Conduct transplant, High Need/High Cost (HN/HC), Serious Mental Illness (SMI), Intellectually/Developmentally Disabled (DD), foster care, and other clinically complex case reviews.
• Chair Ad Hoc Health and Safety Meetings. Co-Chair AHCCCS New Technology and Services Committee. Participate in AHCCCS Medical Director Meetings. Participate in AHCCCS Pharmacy and Therapeutics Committee. Participate in AHCCCS Clinical Oversight Committee. Participate in AHCCCS  Coding and Billing Review Team. 

Knowledge:
• Federal regulations relating to Medicaid and Medicare
• AHCCCS rules, regulations, policies and procedures including AHCCCS medical policies & programs
• Managed care concepts and practices
• Provider community/healthcare delivery system in Arizona
• Claims and coding submission practices
• Current medical practices, procedures, pharmaceutical and devices
• Medical Quality Assurance and Utilization Review methods, practices and processes
• Credentialing standards for all medical, dental, and mid-level providers
• Principles and practices of program/project management, state budgeting, personnel management, operations analysis, and system design
• QISMC, NCQA and JCAHO standards of care
• Validation and statistical analysis of data

Skills:
• Management skills
• Excellent verbal and written communication skills
• Leadership skills
• Testify for AHCCCS in the Appeals and Grievances process as it relates to clinical issues
• Organizational skills to coordinate and keep on-target a large number of programs and projects simultaneously
• Strong computer skills
• Make clinically sound medical decisions regarding covered services for AHCCCS members

Abilities:
• Present to small and large audiences effectively
• Represent AHCCCS effectively to outside entities
• Effectively interact with AHCCCS contractors to develop a spirit of cooperation in oversight of medical care of AHCCCS members
• Multi-task in a fast-paced environment where re-prioritization occurs frequently
• Help lead and motivate a Leadership Team
• Interpret federal and state law and agency rules, regulations, policies and procedures
• Ability to work Telecommute

Minimum:
• Physician license in good standing in the State of Arizona. Board certified preferred.

Preferred:
• Five years experience in a managed care environment. Experience in Medicaid, Medicare or commercial populations. Experience with the design, development and administration of a major health care operations system. Ideal candidate will have knowledge of and experience with Indian Health Service.

• 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 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 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.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

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 (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Other Leaves - Bereavement, civic duty, and military.
• 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

By providing the option of a full-time or part-time 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.

Learn more about the Paid Parental Leave pilot program here. 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 careers@azahcccs.gov.

Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.