AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Behavioral Health Prior Authorization Manager

Division of Fee for Service Management (DFSM)

Job Location:

Address: 801 E. Jefferson Street, Phoenix, AZ 85034

This position has the potential to work from a Virtual Office (VO) setting or may Telecommute based on the needs of the unit and at the discretion of leadership.

Posting Details:

Salary: $83,600 

Grade: 23

Closing Date: Open until filled

Job Summary:

Under the direction of the Clinical Administrator, this position is responsible for the management and oversight of the DFSM Behavioral Health Prior Authorization/Utilization Review (BH PA/UR) unit. Position duties include interaction with Providers, resolution of Provider issues and BH PA/UR reporting. Provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for the members’ physical/acute care services and behavioral health needs.

Monitor over and underutilization, conduct prior authorization reviews, provide oversight and technical assistance, gather, plan, organize and evaluate information from multiple sources, including utilization data, case file reviews and audits. Participate in complex care management clinical staffing as needed, serve as a subject matter expert for Behavioral Health covered services.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Job Duties:

Major duties and responsibilities include but are not limited to:
• Provides direct management of the DFSM BH PA/UR unit, including supervision of the BH PA/UR nurses and other staff. Oversees and directs the technological aspects of the BH PA/UR process and maintains reporting structure and processes.
• Provides oversight and directs team interaction with Fee-for- Service providers, ensures provider issue resolution including grievance and appeals, and provides technical assistance. Works in conjunction with other teams in the Care Management Systems Unit (CMSU), staff and teams in other AHCCCS divisions, and external partners as required on quality related matters, care coordination needs, policies, procedures, and processes related to behavioral health care services.
• Oversight of the BH PA/UR team’s participation in the SMI or SED determination process, special assistance, seclusion and restraint, access to care and out of state placement requests. Oversees and directs interaction with Fee-for- Service Providers, Including Provider issue resolution and technical assistance.
• Acts as a FFS BH subject matter expert while assisting in the development of policies and procedures, as required for delivery of covered behavioral health services.
• As needed, provides backup for the responsibilities held by the BH PA/UR unit and other CMSU functions as needed.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
• Principles and practice of management and supervision, of data research and report development
• Information technology processes and potenti