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Healthcare Operations Coordinator

2 months ago

Phoenix, Arizona, United States Arizona Health Care Cost Containment System Full time
Job Summary:

This position is responsible for overseeing the management of network access to care for service providers. The ideal candidate will have a strong understanding of federal and state regulations related to network requirements, Medicaid provider and managed care plan relations, as well as AHCCCS contract and policy requirements.

Key Responsibilities:
  • Monitor complaints against health plans related to network access to care issues, ensuring adequate network of service providers to meet the needs of the population.
  • Receive, review, research, and respond to access to care complaints received from internal and external stakeholders.
  • Oversee health plan deliverables, review for compliance, and identify any potential access to care concerns.
  • Conduct assessment of network sufficiency by performing network surveys, outreach calls, and secret shopper calls to confirm member access to care.
  • Serve as a representative of the DHCS Network team in committees related to access to care.
Knowledge, Skills & Abilities (KSAs):
  • Knowledge:
    • Provider Network Planning, development, and monitoring
    • Behavioral health, long term care, and physical health service delivery system and operations
    • Medicaid provider and managed care operations
    • Licensure regulations
    • State Medicaid agency regulations
    • Managed care concepts
    • Medicaid provider and managed care options
    • Interpersonal communication/conflict resolution process
    • Project management
  • Skills:
    • Strong interpersonal skills to effectively relate to members and/or their families, multidisciplinary professionals, contractor representatives, and stakeholders
    • Analytical skills
    • Problem solving and trouble shooting skills
    • Group facilitation and organizational skills
    • Information collection and synthesis skills
    • Data analysis, interpretations, and reporting
  • Abilities:
    • Assess network sufficiency through a holistic perspective with emphasis on medical, social, environmental conditions and barriers for meeting unique needs
    • Communicate effectively both orally and in writing within all levels of the organization
    • Exercise initiative, judgment, and problem solving
    • Establish and maintain cooperative working relationships with leadership
    • Research and prepare comprehensive reports
    • Organize work to achieve goals and objectives
Requirements:
  • Minimum:
    • Two years of experience in healthcare and/or project management
  • Preferred:
    • Bachelor's degree in Business or Healthcare Management and 3 years experience in healthcare and/or project management
    • Experience in working in a managed care provider or managed care provider relations environment
Benefits:
  • 10 paid holidays per year
  • Paid Vacation and Sick time off (13 and 12 days per year respectively)
  • Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child
  • 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