Healthcare Program Specialist

2 weeks ago


Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full time

Job Summary:

This position will oversee case management systems in the statewide managed care system, including monitoring and oversight of ALTCS Contractors. The role will work closely with the Medical Management (MM) Manager and the Long Term Care System (ALTCS) Case Management (CM) Manager to ensure the development of a fully integrated MM Unit within the Division of Managed Care Services.

Key Responsibilities:

  • Prepare and implement operating procedures in accordance with program rules and regulations.
  • Monitor compliance with State & Federal regulations pertaining to CM monitoring systems.
  • Prepare and submit administrative and statistical reports for the monitoring and oversight of specialized programs.
  • Lead Contractor Operational Reviews (ORs) 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.
  • Establish training courses for program participants and/or internal team/personnel.
  • Provide technical assistance to Contractors and other personnel as needed.
  • Interpret and develop new/revise existing policies.
  • Coordinate and lead internal and external policy workgroups.
  • Represent the MM Unit in internal and external meetings.

Requirements:

  • Four years professional experience related to health programs.
  • Knowledge of Medicaid and Medicare Federal Regulations, State Statute and Rule, and policies applicable to the ALTCS and other AHCCCS programs.
  • Knowledge of common medical and psycho-social needs of individuals eligible for ALTCS.
  • Ability to collect, review, and analyze data, identify trends, and develop plans and methods for program improvement.
  • Ability to communicate program compliance findings in an objective, non-threatening way to contractors and providers.

Preferred Qualifications:

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

Benefits:

This position offers a range of benefits, including paid holidays, vacation and sick time, paid parental leave, and a top-ranked retirement program with lifetime pension benefits. Additionally, the position provides opportunities for professional growth and development, including training and education programs.

Arizona State Government Benefits:

As an employee of the Arizona State Government, you will be eligible for a range of benefits, including health, dental, and life insurance, as well as retirement savings plans. You will also have access to a range of employee assistance programs, including counseling services and financial planning resources.

Pre-Employment Requirements:

Successful completion of the Electronic Employment Eligibility Verification Program (E-Verify) and a background check are required for this position. Additionally, employees who drive on state business must complete any required driver training and have an acceptable driving record for the last 39 months.



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