Title: Clinical Care Specialist
Clinical Care Specialist
- REMOTE OPTIONS
Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
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.
AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. 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.
Come join our dynamic and dedicated team.
Clinical Care Specialist
Division of Fee For Service Management (DFSM)
Address: 801 E. Jefferson Street.
Phoenix, AZ 85034
This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of expected performance measures.
Salary: $47,000 to $48,399
Closing Date: Open Until Filled
The Division of Fee For Service Management is looking for a highly motivated individual to join our team as Clinical Care Specialist. Under the direction of CMSU Case Management Manager, this position is responsible for processes and projects related to the care management efforts for FFS members. This position will work closely with CMSU staff. Including care management and care coordination support functions, such as monitoring, processing and distribution of care management referrals, outreach, documentation and follow up as directed. This position will serve as the lead for Case Management (CM) projects, including research, development and maintenance of CM resources, processes and desk levels, and tracking and reporting of care management outcomes and data.
This position will outreach to IHS/638 and non IHS/638 facilities to establish relationships and maintain Facility contact and resource data. This position will assist with the Transition of Care ETI Folder, CRS referrals, provider or member outreach, documentation and follow up as directed. This position will respond to provider inquiries related to prior authorization processes, denials, reconsiderations, and other CMSU processes, and will serve as back up to other CMSU team functions.
Major duties and responsibilities include but are not limited to:
* Provide support to the CMSU CM team functions, including care management & care coordination support functions such as monitoring, processing & distribution of care management referrals, outreach, documentation & follow up as directed, managing the Transition of Care ETI folder, CRS referrals, provider or member outreach & documentation & follow up as directed.
* Serve as the lead for care management projects, including the research, development and maintenance of CM care management resources, processes and desk levels and tracking and reporting of care management outcomes and data.
* Respond to provider inquiries, including technical assistance in the areas of prior authorization, denials, reconsiderations and other CMSU processes.
* Outreach IHS/638 and non IHS/638 facilities to establish and maintain facility contact and resource data.
* Cross-train as back up to other CMSU learn functions; serve as backup for implementation of COOP protocols and processes, and tracking and reporting of CMSU care management data.
* Healthcare Delivery Systems.
* Familiarity with Native American Tribes/programs.
* Member psychosocial and medical needs.
* Medicaid, Medicare Federal Regulations, State Statute and Rule and policies applicable to AHCCCS programs.
* ICD and HCPC codes.
* Specific geography of Arizona and New Mexico and surrounding states.
* AHCCCS and DFSM Policies and Procedures.
* Familiarity of authorization and utilization review.
* Medical technology computer data retrieval and input.
* Problem solving skills.
* Excellent verbal/written communication skills.
* Organizational skills to coordinate, monitor and report.
* Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations.
* Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds.
* Documentation and reporting of data and trends.
* Intermediate computer skills (i.e. Microsoft Office Suite, Word, Excel, and Google).
* Strong ability to collaborate with others for mutually beneficial outcomes.
* Plan, organize and prioritize work.
* Multitask in a fast paced environment.
* Understand clinical information.
* Read, interpret, and apply complex rules and regulations.
* Independent decision making yet knowing when to elevate the decision.
* Drive long distances when required.
* Ability to work Virtual Office (VO), Telecommute or both.
* Two years of experience in a healthcare support role.
* Experience in Behavioral Health, prior experience working with Tribal entities.
* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
* Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
* Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
* Other Leaves - Bereavement, civic duty, and military.
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities
Lifetime Pension Benefit Program.
* Administered through the Arizona State Retirement System (ASRS).
* Defined benefit plan that provides for life-long income upon retirement.
* Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
* Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program.
* Voluntary participation.
* Program administered through Nationwide.
* Tax-deferred retirement investments through payroll deductions.
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing email@example.com.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.