Job Description

08/27/2018
SOCIAL AND HUMAN SERVICES 21
PHOENIX 47,476.00-53,000.00

Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

ALTCS Case Management Specialist

 

First resume review: September 4, 2018

 

Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.

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. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!

JOB SUMMARY:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as an ALTCS Case Management Specialist. Under the leadership of the Medical Management (MM) Manager and the Long Term Care System (ALTCS) Case Management (CM) Manager, this position will provide oversight of CM systems within the statewide managed care which will include monitoring and oversight of AHCCCS ALTCS Contractors. Major duties and responsibilities include but are not limited to:

* Monitor compliance with State and Federal regulations pertaining to CM monitoring systems. Prepare for and participate in Operational Reviews (ORs) to include the review of pre-audit documents and policies, on-site audit, formal written documentation of findings and monitoring the Corrective Action Plans as applicable

* Independently monitor one or more specialized programs, such as Over-Institutional Cost, ALTCS Transitional Program, Out-of-State Placements and Acute Care Only programs. Conduct ORs, focused reviews and evaluate effectiveness of actions taken to improve processes and delivery of quality care.

* Investigate and respond to member and/or policy related issues with ALTCS Contractors. Coordinate and communicate with ALTCS Contractors to ensure the health and safety of AHCCCS ALTCS members.

* Provide training and technical assistance to Contractors and other personnel as needed.

* Review, interpret and revise policies.

* Represent the Medical Management Unit in internal and external meetings; and participate in the preparation and facilitation of Quarterly ALTCS Case Management meetings.

* Review of the annual CM Plan for each contractor along with written communication outlining any deficiencies that need to be corrected.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

* Demonstrated knowledge of the ALTCS and AHCCCS program design and implementation, including case management functions and responsibilities, provider network and funding sources.

* Knowledge of the community resources relative to providers of service to AHCCCS and ALTCS clients.

* Skilled in reviewing case documentation in order to evaluate the appropriateness of placements and services for ALTCS members.

* Presentation skills in order to provide technical assistance and training to contractors and staff.

* Ability to collect, review and analyze data, identify trends and develop plans and methods for program improvement.

* Strong ability to organize and prioritize multiple tasks with the ability to re-prioritize as necessary.

* Demonstrated skills in Microsoft Office: Outlook, Word, Excel PowerPoint or comparable software programs.

SELECTIVE PREFERENCE(S):

* Bachelor’s Degree in Social Work or other related healthcare field.

* One-two years working in a managed care environment.

BENEFITS   

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. Click here to learn more about benefits.

 

Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.

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For technical assistance, email [email protected] or call 602-542-4700.

Application Instructions

Please apply for this position by following the link provided below. A new window will open on your screen and you will be directed to the Arizona Health Care Cost Containment System (AHCCCS) employment website.

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