Medical Eligibility Specialist
Medical Eligibility Specialist
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.
Medical Eligibility Specialist - Chinle Office
The Division of Member and Provider Services (DMPS) is looking for a highly motivated individual to join our team as a Medical Eligibility Specialist (PAS Assessor) for the Arizona Long Term Care System (ALTCS) in the Chinle Office. This position will assess customers of all potential populations, elderly and physically disabled (EPD), and developmentally disabled (DD) in both institutional and community-based settings to determine medical eligibility for long term care. Major duties and responsibilities include but are not limited to:
* Drives a state or personal vehicle to conduct comprehensive interactive pre-admission screenings (initial and reassessments) utilizing HEAplus on all age groups in both institutional and community settings. Explains benefits, eligibility requirements and rights and responsibilities to customers.
* Manage and monitor PAS caseload and timeliness, schedule interviews, enter interview notes and score PAS, document follow-up actions with case notes, complete and close PAS assessments within application timeframes utilizing HEAplus..
* Obtains and reviews medical records and other relevant records; gathers data to support eligibility findings; interacts with informants such as family members and caregivers of customers, physicians and other professionals to identify and evaluate medical and psychosocial conditions.
* Interact with other state agencies such as Adult Protective Services (APS), Division of Developmental Disabilities (DDD) and Department of Child Safety (DCS).
* Contact applicants with the outcome of the PAS assessment and provide appropriate community resources for customers determined not eligible.
* Attends staff meetings and participates in exchange of professional information in support of the program. Works on special projects, completes financial eligibility interviews.
* Due to COVID-19 precautions the recruiting process has been adjusted to meet the standard health guidelines outlined by the State. Interviews will be conducted virtually and may also be by way of video conference utilizing a platform like Google Meet/Hangouts or Zoom.
* Demonstrated knowledge of medical, functional and psycho-social problems of the elderly, physically disabled and developmentally disabled children and adults.
* Demonstrated knowledge of medical terminology and procedures.
* Demonstrated knowledge of available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.
* Fundamental principles of medical nursing services, alternatives to long term care, length of stay, pharmacology and equipment use.
* Experience with caseload management; schedules and timetables; effectively prioritizing; analyzing, assessing and evaluating service provisions and quality of care.
* Strong ability to establish and maintain effective working relationships with professional staff, caregivers, customers’ families, children and adults and with representatives of courts and various other agencies in the community.
* Strong ability to communicate effectively, both orally and in writing; reading, understanding and applying rules, regulations and policies.
* Ability to elicit information and gain insight into customers and families; using a personal computer/laptop and computer programs to document information.
* Ability to solve mathematic problems accurately.
* Ability to be fluent in Navajo.
* Meet at least one of the following qualifications: Possess an active Arizona RN license; OR a Bachelor’s or Master’s degree in Social Work or closely related field and 2 years of experience providing social service case management; OR 3 years of experience providing social service case management that included individual planning and delivery of health care services.
* Must possess a current and valid Arizona driver’s license.
* Experience with health care delivery systems and the use of appropriate channels to deliver health care services.
* Understanding of various medical interventions that pertain to the customer’s diagnosis.
* Arizona Drivers License.
* Graduation from an accredited school of nursing, with an active Arizona RV license; OR a Bachelors or Master's degree with a major in Social Work, Rehabilitation, Counseling, Education, Sociology, Psychology, Nursing or other closely related field and 2 years of experience providing social service case management; OR 3 years of experience providing social service case management that included individual planning and delivery of health care services.
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.