AHCCCS

Address: 150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona.

Salary: $72,000 - $78,650

Grade: 23

Position will remain open until filled.

Under the general direction of the Medical Management Manager and Supervisor, this position will monitor and evaluate Medical Management programs for the AHCCCS Acute Care, Arizona Long Term Care System, and Integrated Behavioral Health Contractors.

Major duties and responsibilities include but are not limited to:
• Supervise, train and assist in the distribution of work assignments, work review, performance appraisal, hiring, etc.
• Write, implement, and review of the performance of the AHCCCS Acute Care and Arizona Long Term Care System Health Plans through the Operational and Financial Review process, including the corrective action plans. Technical assistance to Contractors as needed.
• Reviews and analyzes the data provided by Contractors/ Health Plans. Tracks compliance with the reporting of the Contractors / Health Plans per contract guidelines/policies or AHCCCS requests.
• Develop, update, review and interpret AHCCCS policies, rules and regulations, research changes and additions, identify potential issues, communicate impact of changes to division/agency management.
• Reviews, researches and assists in coordination of Transplant Activities for the Tribal Fee for Service members, and provides technical assistance to the Program Contractors/Health Plans regarding transplant policy. Interfaces and reviews compliance of contracted facilities in accordance with the AHCCCS facility contract. Identifies and reports to Manager any deficiencies with facility contract, including outcomes and gaps.
• Reviews Reinsurance medical records. Document findings and analyzes any trends and communicates trends orally and in writing to the Medical Management Manager.
• Communicates with internal and external (health plans/program contractors, members and providers) staff and respond to requests within the designated timeframes.
• Maintains active Catastrophic member list and is responsible for all written communication with the Contractor/ Health Plan regarding approval of members for Reinsurance. Reviews Reinsurance requests and applies medical criteria in the approval or need for Medical Director intervention on case approvals. Reports any untoward trends to the Medical Management Manager.
• Performs other duties as assigned by Manager, Division Assistant Directors or the AHCCCS Medical Director.

Knowledge:
• Principles and practices of Utilization Management
• Federal Regulations, State Statute, Rule, Policy and Procedure governing the AHCCCS program
• AHCCCS contractual arrangements with Health Plans and Program Contractors
• Management information system basic knowledge
• Computer system knowledge in Outlook, Word and Excel
• Health Care management principles and practice
• Current medical knowledge including evidence based medicine standards
• Techniques and methods of managing and supervising staff

Skills:
• Analytical and comprehension skills to interpret utilization management data within the context of federal and state statues, policy, rules and regulations
• Oral and written communication skills
• Organizational skills

Abilities:
• Multi-task in a fast paced environment, re- organize as needed
• Manage and supervise staff
• Communicate with all levels of professionals, corporate and agency officers and members

Preferred:
• Prefer a Masters in Social Work, Nursing, Public Administration, Health Administration, or Business Administration. A Master's degree may substitute for one year of the required work experience.

• 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. Learn more about the Paid Parental Leave pilot program here.
• 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.