Managed Care Program Administrator
Managed Care Program Administrator
The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.
Managed Care Program Administrator
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Managed Care Program Administrator. Under the leadership of the Clinical Programs Administrator within the Division of Health Care Management (DHCM), this position provides management and oversight of the Maternal and Child Health (MCH) and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) programs. The position is responsible for high-level management, support, and operations along with the related functions/systems within the MCH/EPSDT unit. This position provides expertise, leadership and support to ensure the development of fully integrated Clinical Programs within the Agency as well as within the contracted Managed Care Organizations (MCOs). This is a highly collaborative position, working closely with other clinical and non-clinical units across the Agency.
* Manage oversight responsibilities of AHCCCS Contractors in the provision of quality health care, in compliance with federal, state and AHCCCS requirements. Provide support and direction to staff all units. Participate and/ or lead teams in the development, implementation and evaluation of AHCCCS Medical policies, administrative policies and technical assistance tools for the AHCCCS program.
* Ensure compliance with all Federal and State requirements. Participate in Operational Reviews, provide technical assistance, and ensuring monitoring and oversight of the Managed Care Organizations. Evaluate compliance with contractual and/or policy requirements. Ensure the efficacy and effectiveness of health care delivery systems.
* Provide technical assistance and oversight of internal staff, health plans, providers and other external customers related to clinical issues and programmatic implementation of health care services (e.g. medical management, case management), Maternal and Child Health, and EPSDT programs (e.g. Vaccines for Children, Arizona Perinatal Trust, First Things First, Arizona State Immunization Information System)
* Participates in and/or leads Clinical Oversight Committee, Quarterly Medical Director Meetings, Quarterly MM Meetings, Quarterly QM/PI/MCH/EPSDT Meeting, appropriate Agency leadership meetings and other ad hoc meetings. Lead literature reviews that pertain to AHCCCS policy to ensure language conforms to standards of practice, evidence based and meets and balances the needs of members, providers and Contractors.
* Collaborate with state and local health and social service agencies, including but not limited to, ADHS, DES, DCS, Head Start, etc. as well as community and private health care organizations and providers. In addition, collaboration and implementation of requirements with the VFC and Lead Screening programs.
* Responsible for maternity and EPSDT care coordination, with emphasis on preventive health, maternal and child health services, family planning programs, sterilization, pregnancy terminations, EPSDT, dental, and Arizona Early Intervention Program (AzEIP) requirements. Receive, investigate, apply direct intervention, track and trend issues involving AHCCCS members related to EPSDT, maternity, preventive health, family planning, pregnancy terminations, stillbirths and sterilizations. Participate in the member grievance process, review of deliverables, and audits/studies. Manage the review of quarterly and annual deliverables and establishing standards for quality improvement in maternal and child health programs, including but not limited to quality aspects mandated in AHCCCS policy.
* Provide supervision, mentoring, and coaching of staff to ensure compliance with regulations and policies of the Agency. Facilitate regular 1:1s, team huddles, and other communication modalities with the MCH/EPSDT team. Collaborate with the Clinical Administrator on complex staffing needs. Complete performance appraisals, authorize leave, and approve ETE Time Cards.
* Design data requests that inform related areas of responsibility, identify opportunities for improvement, discover gaps in Contractor reporting or performance and validates deliverables submitted. Apply appropriate coding and methodologies to the data requests in order to receive data that informs decision making.
* Represent the Agency (or ensuring coverage) for community and stakeholder meetings. Subject matter expert for the Agency and present to stakeholders and/or lead collaborative efforts to promote AHCCCS initiatives. Ensures acknowledgment to members, AHCCCS Administration, the Governor's office, legislators and other advocacy groups that member issues and concerns have been received, investigated and resolved according to AHCCCS policy and federal and state requirements.
* Support complex member case staffing; bringing swift resolution to issues, providing technical assistance to MCOs and/or other stakeholders involved, and ensuring follow-up and resolution of issues as well as systemic improvements as appropriate. Leadership role for developing/providing input into RFP processes, contract and policy amendments. Participate in RFP and amendment work groups, steering teams and scoring teams.
* State and Federal Policies and Procedures * Empathetic interaction with members and governing Title XIX, Title XXI, and AHCCCS- families on issues or concerns that are specific populations
* Principles and practices of program planning; assessment skills; Maternal Child Health and EPSDT service delivery models; preventative health practices; organization of health care systems and current trends that affect the systems
* Clinical knowledge of conducting case reviews/member case staffing and ability to support complex care needs and member/ MCO concerns
* Effectively collaborating with all levels of health care professionals and stakeholders
* Monitoring policies and procedures that result in holistic health care and/or enhance existing processes to achieve better outcomes
* Providing effective guidance and technical assistance regarding health care issues and the administration of AHCCCS programs
* Assess members from a holistic perspective with an emphasis on recognizing medical, social, environmental and emotional conditions, barriers for meeting medical needs that interfere with the member's ability to function within his/her limitations
* Certified Professional in Healthcare Quality
* RN or LPN - Baccalaureate degree in nursing
* Two-three year experience working in a managed care environment that includes one year of supervisory experience
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.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.