Job Description

Post Date 09/10/2019 Close Date Category HEALTHCARE PROFESSIONALS Grade 2 Location PHOENIX Salary 200,000.00-243,000.00

Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

Medical Director

 

First Resume Review: 09/17/2019

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!

JOB SUMMARY:

The Office of the Director (OOD) /Chief Medical Officer (CMO) is looking for a highly motivated individual to join our team as a Medical Director. This position will report to the CMO and be responsible for medical director functions for the AHCCCS Fee For Service (FFS) populations under the Division of Fee for Service Management (DFSM) as well as provide medical oversight of managed care organizations (MCOs) through the Division of Healthcare Management (DHCM). Major duties and responsibilities include but are not limited to:

* Perform medical management and quality management medical director functions for DFSM.  Medical management functions include service prior authorization, retrospective review, and concurrent review.  Quality management functions include review of quality of care (QOC) cases and chairing DFSM peer review committee.

* Consult with the DHCM Clinical Resolution Unit, Medical Management, and Quality Management on member level issues and coordinate with Managed Care Organization’s (MCOs) to resolve issues.

* Serve as medical SME for AHCCCS Medical Policy Manual and FFS policy updates.

* Supervise opioid staff providing clinical direction and leadership of related efforts.

* Consult with Office of Administrative Legal Services (OALS) on AIHP and MCO appeals and state fair hearing (SFH) requests and decisions. Serve as medical consultant on Serious Mental Illness (SMI) grievance cases.

* Consult with Targeted Investment Program staff and other programmatic areas in need of medical SME.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of:

* Federal regulations related to Medicaid, Medicare and health insurance programs

* Demonstrated knowledge of AHCCCS rules, regulations and medical policies

* NCQA 

* Disease management program requirements

* Medical data and information analysis

* Health plan operations, medical practices, pharmaceuticals and benefit management

* Managed care medical model

* Chronic disease management model

* Public health and population health status improvement

* Long-term care services and programs

* Claims and medical coding processes

* The Arizona provider community

Skills:

* Excellent verbal and written communication skills

* Excellent presentation skills

* Organization and behavioral management skills

* Leadership skills

* Good medical practice skills

* Skilled negotiator and conflict manager

Ability to:

* Coordinate, evaluate and make decisions regarding complex medical issues

* Interpret the laws, rules, regulations governing the assigned program areas, and develop policy

* Establish and maintain effective relationships with those contacted in the course of work

* Develop a work plan and anticipate all work steps including potential issues

* Demonstrate strong abilities in high level research and analysis

* Prioritize in a fast paced environment

* Coordinate multiple projects, keeping on task and meeting deadlines

LICENSES/CERTIFICATION(S):

* Licensed M.D. or D.O. in good standing in the State of Arizona

* Board Certified in Family Practice, Pediatrics, OB/GYN, Internal Medicine, General Surgery or other Medical Specialty recognized by the American Board of Medical Specialties

* Arizona driver license

SELECTIVE PREFERENCE(S):

* Advanced degree in public health, business administration, or certification in QM/UM or peer review

* Experience as the Medical Director for MCO or other healthcare institution serving Medicaid members

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.

Click the APPLY NOW button to submit your application.

For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.

Application Instructions

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.

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