ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Health Program Manager I
First Resume Review: 08/28/2020
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 a Health Program Manager I. Under direction of the Business Analysis Manager, this position will be responsible for planning and managing research projects, related to the design, implementation, and analysis and reporting of medical audits, quality indicators, studies, performance measures, clinical and utilization management studies for the AHCCCS Office of Data Analytics (ODA). This position will coordinate, interface, and work with associated managed care organizations, research organizations, and various other agencies as required by project requirements. This position will provide assistance to work groups on data collection and statistical analysis and program monitoring, and is responsible for functions involving Utilization Review and Quality Assurance subsystem (UR/QA). This position will carry out project plans, code and perform analysis of UR/QA reports and claim details. This position will participate in cross training with peers in the AHCCCS Office of Data Analytics unit; assist peers with completion of assigned projects as necessary. Prepare, submit, and track system service requests, and serve as a resource to both internal and external customers. Major duties and responsibilities include but are not limited to:
* Provide technical assistance on various projects, such as the outcome of UR/QA and claim detail reports, performance measures, immunization audit, annual medical audit and other ongoing projects
* Develop spreadsheets, tables and graphs for various projects.
* Gather, analyze, and interpret data. Collect and gather necessary parameters and codes for data requested
* Provides basic analysis and interpretation of outcome of reports.
* Research data inconsistencies, problems and meet with systems personnel for resolutions.
* Design and develop methods to collect provider and member utilization and costs.
* Represent the agency/division to outside agencies/organizations.
* Participates in departmental and agency meetings
KNOWLEDGE, SKILLS AND ABILITIES (KSAs): * Utilization Review and Quality Assurance (UR/QA) Subsystem.
* Concepts and techniques of data processing, research and statistical analysis methods; data collection system; concepts of program planning and design, familiarity with computer programming; medical data collection; medical terminology.
* CPT-4, ICD-9, HCPCS, HEDIS coding manuals and PMMIS user reference manual.
* Recipient, Provider, Reference, System Service Request and UR/QA Subsystems.
* Mainframe data systems, statistics, health field and management.
* PC software, MS Access, Excel, Power Point, SPSS, MS Word
* Establish and maintain interrelationships in the work environment.
* Organization skills for setting priorities, scheduling and completing work in a timely manner.
* Develop, implement and maintain logical systems and procedures.
* Analyze, review and evaluate data file activities.
* Communicate effectively verbal and written.
* Analytically review and evaluate program activities.
* Operate a computer, to produce various letters, memos, forms, spreadsheets, tables, graphs and maintain database.
* Evaluate program performance and resolve problems of noncompliance.
* Analytical ability, problem solving, identification, evaluation, and assessment of various projects.
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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