Health Program Manager 3

Job Summary:

Under the leadership of the Medical Management (MM) Manager and the Long Term Care System (ALTCS) Case Management (CM) Manager, this position will provide oversight of CM systems within the statewide managed care which will include monitoring and oversight of AHCCCS ALTCS Contractors. The position will actively participate in MM Unit initiatives and programs and provide support to ensure the development of a fully integrated MM Unit within the Division of Managed Care Services, and in the evaluation, development, and implementation of Federal regulations and other AHCCCS initiatives.

Major duties and responsibilities include but are not limited to:

• Prepares and implements operating procedures in accordance with program rules and regulations, including but not limited to monitor compliance with State & Federal regulations pertaining to CM monitoring systems.
• Prepares and submits a variety of administrative and statistical reports for the monitoring and oversight of one or more specialized programs (e.g.: Over-Institutional Cost, ALTCS Transitional Program, Out-of-State Placements and Acute Care Only program). 

• Team Leader for Contractor Operational Reviews (ORs), focused reviews, to evaluate the effectiveness of actions taken to improve processes and delivery of quality care.
• Investigate and respond to member and/or policy related issues with ALTCS Contractors. Coordinate & communicate with ALTCS Contractors to ensure the health and safety of AHCCCS ALTCS members.
• Establishes training courses for program participants and/or internal team/personnel. Provides technical assistance to Contractors and other personnel as needed. Will attend meetings and seminars related to the this position, as budget allows.
• Interpret and develop new/revise existing policies. Coordinate and lead internal and external policy workgroups
• Represent the MM Unit in internal and external meetings.
• Lead review and response of the annual CM Plan MCO submissions, with written correspondence outlining any deficiencies requiring corrective action.
• May serve in the absence of the CM Program Manager.
• Other duties as assigned as related to the position (typically 5% - 10%)

Knowledge:
• Medicaid and Medicare Federal Regulations, State Statute and Rule and policies applicable to the ALTCS and other AHCCCS programs
• Common medical and psycho-social needs of individuals eligible for ALTCS
• Agency functions and inter-relation (i.e., AHCCCS, Center for Medicare and Medicaid Services [CMS], ADHS, DES/DDD, AHCCCS Health Plans, ALTCS Program Contractors and non-Medicaid disability and aging programs)
• ALTCS and AHCCCS program design and implementation, including case management functions and responsibilities, provider network and funding sources
• AHCCCS computer systems, Prepaid Medical Management Information System(PMMIS) and AHCCCS HEAplus, including Case management, Medical and Financial eligibility, Provider and Recipient subsystems
• Community resources relative to providers of service to AHCCCS and ALTCS clients

Skills:
• Reviewing case documentation in order to evaluate the appropriateness of placements and services for ALTCS members
• Interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds and those in crisis
• Oral and written communication, including writing of reports and general correspondence
• Presentation skills in order to provide technical assistance and training to contractors and staff
• Time management and initiative, with ability to work with little or no supervision
• Microsoft Office (Word, Excel, PowerPoint, Outlook) or comparable software program
• Organization and prioritization of multiple tasks and ability to re-prioritize as necessary

Abilities:
• Assess members from a holistic perspective and psycho-social emphasis, recognizing medical, environmental and emotional conditions or barriers that interfere with the member's ability to function at his/ her highest level of independence
• Collect, review and analyze data, identify trends and develop plans and methods for program improvement
• Recognize cause and effect in identified areas of non-compliance; evaluate program performance and resolve problems of noncompliance
• Communicate program compliance findings in objective, non-threatening way to contractors and providers
• Read, interpret and apply complex rules and regulations

Minimum
• Four years professional experience related to health programs appropriate to the assignment, which includes program planning or administration; a Master's degree in a field appropriate to the assignment may substitute for one year of the required experience.

Preferred:
• Bachelor's Degree in Social Work or other related healthcare field. One or more years working in a managed care environment.

• 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 .) 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: 

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

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

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 pilot program . For a complete list of benefits provided by The State of Arizona, please visit our

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.