Health Program Manager 1

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 Managed Care (DMC) Job Location: 150 North 18th Avenue Phoenix, Arizona 85007 Posting Details: Must Reside in Arizona. Salary: Up to $55,000 Grade: 20 FLSA Status: Exempt This position will remain open until filled. This position may offer the ability to work remote, within Arizona, based upon the agency’s business needs and continual meeting of expected performance measures. Job Summary: The purpose of this position is to implement the Pre-admission Screening and Resident Review (PASRR) program for Arizona residents admitted to a skilled nursing facility. This position is responsible for coordinating and evaluating Level I and Level II PASRR submissions to ensure compliance with Federal and State rules and regulations related to PASRR. This position audits submissions for accuracy and completeness and utilizes clinical judgment to evaluate decisions made by submitting providers and ensures that Level II requests are processed in accordance with policies and reviewed timely by the third-party clinicians. This position may offer the ability to work remote, within Arizona, based upon the department's business needs and continual meeting of expected performance measures. The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance. Job Duties: Major duties and responsibilities include but are not limited to: Coordinate and monitor the processing of PASRR referrals and evaluations. Use clinical judgement to evaluate the accuracy and completeness of Level I and Level II submissions as well as to determine which third-party reviewer is best suited to address Level II submissions (behavioral health professional or intellectual/developmental disability professional). Maintain the PASRR mailbox/Portal and update the PASRR database to monitor and track clients. Provide support to providers by addressing inquiries and/or connecting providers with ISD or other appropriate resources. Resolve discrepancies and provide general problem solving efforts regarding the PASRR program (e.g. concerns, appeals, grievances Assist with development and monitoring of the program policies and procedures, including performance audits to ensure conformance with federal and state laws, and all legal mandates. Support training initiatives and provide technical assistance to internal staff, MCOs and providers as needed. Interpret Federal and State rules and regulations. Maintain client records and referrals. Attend meetings, seminars and conferences related to program. Other duties as assigned as related to the position (typically 5% - 10%) Knowledge, Skills & Abilities (KSAs): Knowledge: Federal and State laws and regulations Program planning and design Local, state and federal program resources Statewide hospitals and nursing facilities Medical and psychiatric terminology PASRR, department policy and procedures Applicable commercial software application and usage Record maintenance and report development methodology Skills: Program planning, development and monitoring Demonstrated written and oral communication Listening, interviewing and eliciting information to support program objectives Interpersonal skills to establish and maintain effective working relationships Program monitoring and auditing Intermediate computer skills and basic data entry Clinical review and program determinations Abilities: Review, evaluate, plan and organize health program activities and establish priorities Effectively problem solve Interact with difficult individuals and situations Evaluate compliance with policies and/or regulation Qualifications: Minimum: Two years of professional experience related to health programs appropriate to the assignment. Associates degree in a field appropriate to the assignment may substitute for one year of the required experience. Preferred: Bachelor's degree a healthcare related field and/or 2-3 years of work experience related in Analytics, Auditing, Health Care, or Behavioral Health. Strong computer skills, understanding of State and Federal policies and procedures governing Medicaid and Medicare and knowledge of PASRR policies and procedures. Pre-Employment Requirements: Pre-Employment Requirements: 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.) 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) Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here. 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 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. Learn more about the Paid Parental Leave program here. 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 View email address on click.appcast.io. 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. #J-18808-Ljbffr Arizona State Government