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.

Clinical Review Unit Manager

Division of Fee for Service Management (DFSM)

Job Location:

Address: 150 N. 18th Avenue Phoenix, Arizona 85007

All AHCCCS employees must reside in Arizona.

Posting Details:

Salary: $83,600 

Grade: 23

FLSA Status: Exempt

Closing Date: Open until filled

Job Summary:

Under the direction of the Utilization Review (UR) Administrator, this position is responsible for the management and oversight of Division of Fee for Service Management (DFSM) Clinical Review Unit (CRU) staff, ensuring the timely and accurate completion of clinical reviews in various clinical units within the DFSM. Oversight includes technological aspects, interaction with providers, resolution of provider issues and unit reporting.

This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.

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 Clinical Review Unit and manages the nursing staff and non-nursing staff. Participates in Division and Agency Policy Committees. Oversees and directs the technological aspects of the CRU processes and maintains reporting structures and processes.
• Provides oversight and directs team interaction with Fee-for-Service (FFS) Providers and stakeholders, ensures provider issue resolution including grievance and appeals, and provides technical assistance. Works in conjunction with other clinical teams in the DFSM, 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 health care services.
• Oversight of the team’s participation in special processes (i.e. SMI or SED determination, OHR assistance, seclusion and restraint, out of state placements, etc.) Provides oversight and directs team interactions with FFS Providers, including provider issue resolution and technical assistance.
• Provides backup for the responsibilities held by the CRU nurses as needed.
• Acts as a FFS subject matter expert while assisting in the development of policies and procedures, as required for delivery of covered health care services.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
• Medical terminology
• CPT and ICD procedural coding
• Industry standards for retrospective utilization review, prior authorization and assignment of levels of care
• Medical billing guidelines
• Broad scope of knowledge of clinical protocols, current medical and nursing practices, and alternative courses of medical treatment and expected outcomes.
• Grievance proceedings and professional expert testimony
• Principles and practices of administration
• Concept