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Network Access Manager
2 months ago
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:
- 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
- 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
The State of Arizona offers a comprehensive benefits package, including:
- 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
The State of Arizona offers a lifetime pension benefit program administered through the Arizona State Retirement System (ASRS), as well as a Deferred Retirement Compensation Program administered through Nationwide.
