Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Deputy Assistant Director for Managed Care Clinical Compliance
First Resume Review: 04/30/2020
This position will remain open until filled.
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!
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Deputy Assistant Director. The Deputy Assistant Director for Managed Care Clinical Compliance position is responsible for directing expansive clinical initiatives and frequently makes programmatic and policy decisions independently as well as on behalf of the DHCM Clinical/Operations Assistant Director and the AHCCCS Chief Medical Officer (CMO). The position is responsible for leading the DHCM clinical teams, including the Medical Coding, Medical Management, Clinical Resolution, Maternal Child/EPSDT, Quality Improvement, and Quality Management units. Additionally this position provides leadership, priority setting, and support to the DHCM Integrated Care Program as well as the Clinical Informatics team. Major duties and responsibilities include but are not limited to:
* Administration and oversight of the Clinical Units to maintain a coordinated, cohesive team. Meet all deliverable deadlines. Support positive morale, address issues and concerns, and proactively identify/ address issues/barriers. Serves as decision-maker for clinical programs/operations on behalf of CMO and DHCM AD.
* Lead and/or attend Division and Agency meetings/committees as well as external stakeholder meetings related to the clinical programs/initiatives. Represent DHCM at Medical Director, Medical Management, Quality Management, and other meetings. Develop/maintain relationships with stakeholders, government agencies, regulatory and provider organizations, and advocacy groups - serving as an AHCCCS SME, providing guidance and clarification on AHCCCS policies and initiative.
* Reviewing and interpreting federal and state legislation, providing feedback related to potential impact to efficacy/efficiency of the Medicaid program. Develop/review AHCCCS policy to be consistent with regulations/legislation. Able to make policy decisions and interpretations independently.
* Participation in RFPs, waiver development/evaluation, grant writing and other program development requirements. Coordinate and oversee contracts and intergovernmental agreements applicable to the Clinical units.
* Special projects and assignments, including but not limited to legislative deliverables, federal reporting, MCO technical assistance, the AHCCCS COOP team. Serve as a subject matter expert for issues, concerns, grievance/appeals, administrative hearings, legislative hearings, and/or legal proceedings related to clinical aspects of the managed care delivery system
* Lead and/or support processes related to Immediate Jeopardy/serious incidents or concerns involving immediate care needs/substantial impact to members, which may include immediate onsite evaluation of member health/safety. Serve as Agency authority related to incidents and coordinate with other state agencies to remediate emergent/urgent member concerns.
* Participate in AHCCCS Quality committees; lead reviews/case prep and determine recommendations for bed holds, suspensions and terminations of providers due to quality of care or quality of service. Coordinate clinical activities with the DFSM clinical team when projects/initiatives will benefit the FFS population.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Demonstrated knowledge of Federal and State regulations relating to Medicaid and Medicare
* Knowledge of Clinical Quality and Medical Management/utilization review methods, practices and processes
* Knowledge of Federal and State law and agency rules, regulations, policies and procedures for clinical services in a managed care environment
* Knowledge of standards of care, especially for members who are vulnerable and/or diagnosed with clinically complex conditions.
* Strong interpersonal skills in dealing with staff, peers, Agency leadership, and external stakeholders
* Effective organizational skills to coordinate and keep on-target a large number of high-priority programs and projects simultaneously.
* Ability to work closely in a positive manner with the Governor’s Office, other state agencies, county officials, stakeholders, MCOs, etc.
* Minimum of five years of progressive work experience in managed healthcare
* Arizona licensed registered nurse or a Certified Professional in Health Care Quality (CPHQ)
* Advanced degree in health care administration
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) 417-4678. 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 HRIShelpdesk@azdoa.gov or call 602-542-4700.