• 516699

• PHOENIX
• REMOTE OPTIONS

• AHCCCS

• Full-time

AHCCCS

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.

Address: 801 E. Jefferson Street, Phoenix, AZ 85034

Salary: $70,400

Grade: 21

Opened Until Filled

This position is responsible for the oversight and review of the quality of care concern investigation process involving behavioral health services and providers. This position is responsible for communication and collaboration with contracted health plans, participating in the development, implementation, and monitoring of the quality care management functions within the DHCS Clinical Quality Management Unit, other divisions with AHCCCS, and other State agencies. After initial training and orientation, this position will be primarily virtual (work from home) with some in office meetings.

Major duties and responsibilities include but are not limited to:
* This position is responsible for the oversight and review of the quality of care concern investigation process involving behavioral health services and providers. This position is responsible for communication and collaboration with contracted health plans, participating in the development, implementation, and monitoring of the quality care management functions within the DHCS Clinical Quality Management Unit, other divisions with AHCCCS, and other State agencies. After initial training and orientation, this position will be primarily virtual (work from home) with some in office meetings.
* Participate in operational reviews, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, corrective action plans, notices to cure and sanctions as appropriate.
* Ensure quality of care to AHCCCS members, including ensuring member health and safety as well as dignity and respect. Focus on unique aspects of each case, individual care needs, timely correspondence with members, and timely acknowledgment of concerns as well as resolution of the issue. Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.
* Provide technical assistance to Contractors, as appropriate, regarding contractual and/or
policy requirements to improve quality of care and service delivery to AHCCCS members.
* Participate in the development of improved processes and procedures to improve efficiency of the QM unit. Participate in special projects and reviews as assigned and assure completion within the designated timelines. Provide ongoing updates to CQM Management.
* Coordinate and complete tracking, evaluation, and response to Contractor deliverables.

Knowledge:
* Structure and operation of the Arizona behavioral health system
* SMI grievance and administrative appeal processes; rules, status and regulations that define the standards of care applicable to the behavioral health system
* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, Behavioral Health, LTC and Tribal and Children’s Rehabilitative Services
* Behavioral health services, case management protocols, utilization review protocols as related to assigned populations (e.g. Acute, behavioral health, Long Term Care)
* Knowledge of current standards of medical/behavioral practice and modes of delivery for acute and non-acute medical/behavioral care/services

Skills:
* Techniques to select a particular approach to analyze develop or implement a policy, project management methodologies and Behavioral Health delivery system
* Strong interpersonal skills to effectively
relate to AHCCCS members, their families, and Agency stakeholders
* Behavioral Health processes including assessment, treatment planning, intervention, and evaluation
* Understanding of and experience with special health care needs populations
* Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic backgrounds; project management to meet goals and deadlines

Ability:
* 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 at an optimal level
* Communicate orally and in writing with members, contractors, and providers to facilitate resolution or presenting issues
* Collaborate with others for mutually beneficial outcome to make effective decisions in a high volume fast paced environment; and strong organizational skills for setting priorities, workload and record keeping
* Read, interpret, and apply complex rules and regulations
* Work in a virtual environment

Minimum:
* Three years of management analyst experience appropriate to the assignment; OR five years of experience appropriate to the assignment. Bachelor's or Master's degree in a field appropriate to the assignment will substitute for one or two years of the required experience respectively, but will not substitute for required management analysis experience.

Preferred:
* Certified Professional Healthcare Quality.
* At least two-year professional healthcare industry experience in Quality or Utilization Management; OR five years of experience in the behavioral health field, preferably in the context of the delivery of service in Arizona’s public behavioral health system.

* 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)
* 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

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

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 careers@azahcccs.gov.
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.