Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
First Resume Review: 01/25/2019
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 Office of Administrative Legal Services (OALS) is looking for a highly motivated individual to join our team as a Junior Investigator. This position will perform investigations of physical and sexual abuse and sexual misconduct that occurred in a mental health agency or as a result of an action of a person employed by a mental health agency. Major duties and responsibilities include but are not limited to:
* Perform complex investigations of SMI abuse/death. Conducts statewide in-person and/or telephonic interviews of witnesses, staff, SMI consumers, and alleged perpetrators; reviews and processes data, documents, and medical records; drafts investigation reports, decision letters, appendixes, and maintains case files; testifies as a witness at administrative fair hearings.
* Mediates informal conferences for appeals of contractor decisions relating to behavioral health services for persons with SMI.
* Provides technical assistance to contractors and other stakeholders regarding Title XIX/XXI appeals, claim disputes, SMI grievances and SMI appeals. Reviews and provides feedback regarding deliverables from contractors.
* Other duties as assigned as related the position.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Must have knowledge of federal and state laws and civil and administrative laws; AHCCCS policies and procedures related to the grievance and appeal process for Title XIX/XXI enrollees and/or persons with SMI
* Demonstrated knowledge of claim processing procedures, financing contracts and operation of RBHAs; regulations and policies and procedures that apply to RBHAs and various providers who contract with them; RBHA risk management incident/accident/death AHCCCS reporting requirement; medical terminology and procedure to review specific medical records; legal compliance issues of confidentiality, release of records, release of information and subpoenas
* Demonstrated knowledge of investigative methods, techniques, and approaches necessary to plan and conduct investigations of a highly sensitive nature relating to physical abuse, sexual abuse, sexual misconduct, and deaths of SMI consumers
* Demonstrated knowledge of performance management (PM) model and continuous quality improvement (CQI) methods in a public health setting; SMI consumer evaluation, assessment, individual service planning, and at-risk crisis planning
* Strong ability to effectively and efficiently address grievance and appeal issues by utilizing a combination of exemplary writing skills, excellent verbal communication skills and excellent analytical skills, databases, Microsoft Excel, Word, and PowerPoint and/or other comparable software programs.
* Requires possession of and ability to retain a current, valid state-issued driver's license appropriate to the assignment.
* CLEAR investigator certification or equivalent Investigator training or the ability to obtain CLEAR Investigator certification. An academic background indicative of exemplary writing skills, excellent verbal communication skills, and excellent analytical skills
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.
Click the APPLY NOW button to submit your application.
For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.