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 Health Program Manager 1. This position will respond to inquiries and complaints received by members, family and community members, provider and advocacy groups, the legislature, other agencies and referral sources that are made by telephone, in person, or through written correspondence. Major duties and responsibilities include but are not limited to:
* Answers inquiries and complaints from external customers (including members, providers, families, stakeholders, the community and other agencies) received via telephone, in person or through written correspondence.
* Responds to difficult inquiries and complaints by working with Contractors, conducting research, gathering information, reviewing relevant resources such as Covered Service Gide, policies and procedures and applicable laws and regulations to resolve problems
* Facilitates problem resolution through Contractor staff in coordination with other bureaus and staff within AHCCCS other agencies, systems and partners and triages issues and concerns to indicated areas, including team and Office Chief, Offices for SMI grievances and appeals, Human Rights, Individual and Family Affairs, quality Management, fraud and abuse and medical leadership.
* Maintains complaint records and documentation for tracking and trending.
* Provides Information about client rights, programs, rules, regulations, policies, procedures and practice and service guidelines.
* Evaluates Contractor compliance, makes system improvement recommendations and participates in improvement activities.
* Provides technical assistance and training to Contractor staff and evaluates performance related to resolution of problem issues.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Knowledge of the Arizona public behavioral health system; Arizona Administrative Code; Medicare and Medicaid (AHCCCS) programs, rules, regulations and policies including those pertaining to SMI and member rights, service planning and services provision, grievance processes, provider manuals and covered services.
* Knowledge and understanding of medical terminology and general knowledge of health plan services including benefit and eligibility information, billing and payment issues, customer material requests, physician assignments, authorization for treatment and explanation of benefits.
* Excellent customer service, listening and interpersonal skills.
* Strong and effective written and oral communication, analytical thinking, research, development of a plan of action, problem solving, organization and orientation to detail.
* Ability to learn new computer applications to include PMMIS and CIS/Databases
* Ability to analyze clinical and complaint information and utilize this information to recommend system improvements.
* Ability to read and understand various materials, files, documentation and other information within the department
* Academic training in courses such as social work, psychology, sociology, counseling, medical terminology, behavioral health and substance use disorders, dispute resolution and related working experience in the behavioral health field preferably through direct service delivery or managed care and knowledge of assessment and service planning, confidentiality and grievance system process.
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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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.