The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Program Specialist. This position is responsible for the oversight and review of the quality-of-care concern investigation process involving behavioral health services and providers. This position is responsible for communication and collaboration with contracted health plans, participating in the development, implementation, and monitoring of the quality care management functions within the DHCM Clinical Quality Management Unit, other divisions with AHCCCS, and other State agencies.
• Participate in operational reviews, technical assistance and focuses studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, corrective action plans, notices to cure and sanctions as appropriate.
• Provide technical assistance to Contractors and FFS providers, as appropriate, regarding contractual and/or policy requirements to improve quality of care and service delivery to AHCCCS members. Participate in special projects and reviews as assigned and assure completion within the designated timelines. Provide ongoing updates to leadership.
• Participate in the development of improved processes and procedures to improve efficiency of the QM unit. Participate in special projects and reviews as assigned and assure completion within the designated timelines. Provide ongoing updates to leadership.
• Receive, research, document and resolve quality of care issues utilizing standardized processes and centralized databases. Track, trend and monitor status of cases to ensure thorough and timely completion as well as appropriate referrals. Primary emphasis will be placed on special populations such as those utilizing behavioral health services. Ensure research and resolution of quality-of-care issues in a timely manner as assigned and identify systemic issues for AHCCCS to address.
• Ensure quality of care to AHCCCS members, including ensuring member health and safety as well as dignity and respect. Focus on unique aspects of each case, individual care needs, timely correspondence with members, and timely acknowledgment of concerns as well as resolution of the issue. Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.
• Coordinate and complete tracking, evaluation and response to contractor deliverables.
• Knowledge of current standards of medical/behavioral practice and modes of delivery for acute and non-acute medical/behavioral care/services.
• Knowledge of Structure and operation of the Arizona behavioral health system
• Strong interpersonal skills to effectively relate to AHCCCS members, their families and Agency stakeholders.
• Techniques to select a particular approach to analyze develop or implement a policy, project management methodologies and Behavioral Health delivery system.
• Communicate orally and in writing with members, contractors, and providers to facilitate resolution or presenting issues.;
• Collaborate with others for mutually beneficial outcome to make effective decisions in a high volume fast paced environment; and strong organizational skills for setting priorities, workload and record keeping.
• Read, interpret and apply complex rules and regulations.
• Certified Professional Healthcare Quality
• At least two-year professional healthcare industry experience in Quality or Utilization Management or five years of experience in the behavioral health field, preferably in the context of the delivery of service in Arizona’s public behavioral health system.
• Arizona Drivers License
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.