• Job Description

  Req#: 518140

  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.

  Health Program Manager 1

  Division of Health Care Services

  Job Location:

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

  Posting Details:

  Salary: $40,496 - $55,000
  

  Grade: 20
  

  Open Until Filled

  Job Summary:

  This position will respond to inquiries and complaints that are made by telephone, email, and other written correspondence as submitted by members, their families and the community, providers and advocacy groups, the legislature, other agencies and referral sources. Primary duties include providing information about the program and services; education related to member rights and grievance system processes as applicable by population type, rules, regulations, and policy and procedures; oversight and facilitation of problem resolution through AHCCCS health plans; and coordination with internal staff and work units, and other involved agencies.
  
  Maintains accurate, detailed, and timely documentation and case records, tracks and trends individual and systemic issues and concerns, analyzes complex issues, needs, and findings; identifies network concerns, evaluates health plan performance and operations, provides technical assistance, and makes improvement recommendations; may participate as a member of committee meetings and work groups. Shares responsibility for facilitating administrative decertification and opt out processes and processing Jacob's Law concerns.

  Major duties and responsibilities include but are not limited to:
  • Answers inquiries and complaints from external customers (Including members, providers, families, stakeholders, the community, & other agencies) received via telephone or through written correspondence.
  • Receives and responds to difficult inquiries and complaints through fact finding, working with contractors, conducting research, gathering information, reviewing relevant resources including contracts, policies and procedures, applicable laws and regulations to resolve problems.
  • Facilitates and oversees issue resolution through contractor staff, triages and coordinates, as indicated with other units and Divisions related to AHCCCS and SMI eligibility, special assistance needs, grievance system processes and member rights, quality concerns, fraud/waste/abuse, and member treatment needs.
  • Maintains complaint records and documentation for tracking and trending.
  • Provides information about community resources, member rights, AHCCCS program, rules, regulations, policies, procedures, and practice and service guidelines, individual service planning.
  • Evaluates contractor compliance, makes system improvement recommendations, and participates in improvement activities.
  • Provides technical assistance and training to contractor staff and evaluates performance.
  • Facilitates SMI opt out and decertification processes.

  Knowledge, Skills & Abilities (KSAs):

  Knowledge:
  • The Arizona public behavioral health system; Arizona Administrative Code; Medicare and Medicaid (AHCCCS) programs, rules, regulations, and policies, including those pertaining to SMI and member rights, service planning and service provision; grievance processes, provider requirements and covered services
  • Knowledge and understanding of medical terminology
  • Knowledge of health plan services, including benefit and eligibility information, billing and payment issues, member material, physician assignments, authorization for treatment
  • Knowledge of Arizona's behavioral health system, A.A.C. R9-21 and A.AC. R9-20, A.A.C. R9 32, array of covered services
  
  Skill:
  • Excellent customer service, listening, and interpersonal skills
  • Strong computer skills, Microsoft (Excel, Word, Sharepoint, One Drive) and Google applications (Docs, Sheets, Gmail, Chat, Calendar)
  • Strong organizational skills
  • Strong and effective written and oral communication; investigative and fact-finding skills, analytical thinking; research; development of a plan of action; problem solving; organization; orientation to detail
  
  Ability:
  • Learn new computer applications
  • Good complex and creative problem solving abilities
  • Be flexible, focused, and solution oriented,
  • Think critically, multitask, and problem solve
  • Ability to read and understand files, documentation, and other information within the department
  • Ability to analyze clinical and complaint information and utilize this information to recommend system improvements
  • Ability to apply resources, policy, contract requirements, applicable rules, regulations, and procedures to the work unit

  Qualifications:

  Minimum:
  • Two years of professional experience related to health programs appropriate to the assignment. A Master's degree in a field appropriate to the assignment may substitute for one year of the required experience.
  
  Preferred:
  • Academic training in courses such as social work, psychology, sociology, medical terminology, behavioral health & substance use disorders, dispute resolution, and related working experience in the behavioral health field preferably through case management, direct service delivery or managed care, knowledge of assessment and service planning, confidentiality, and grievance system process.

  Pre-Employment Requirements:

  • 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.

  If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.
  

  All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

  Benefits:

  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

  By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

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

  Retirement:

  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.

  Contact Us:

  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. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.

• About the company

  Arizona is on a mission to become the #1 state in the nation in which to live, work, play, get an education, and retire. Arizona state government plays a vital role in making this happen, and in order to maximize our potential the State of Arizona must operate in way that demonstrates a business-like approach. We are looking for enthusiastic and talented people to join the team.

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