Program Development Specialist Senior
1 month ago
This position is responsible for managing, researching, and coordinating concerns related to network access to care of service providers. Having an 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, including tracking and managing complaints related to access to care.
- 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.
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.
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.
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