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.

Health Program Manager 3

Division of Managed Care Services (DMCS)

Job Location:

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

Posting Details:

Salary: $67,567

Grade: 22

Open Until Filled

Job Summary:

Under the leadership of the Medical Management (MM) Manager and the Long Term Care System (ALTCS) Case Management (CM) Manager, this position will provide oversight of CM systems within the statewide managed care which will include monitoring and oversight of AHCCCS ALTCS Contractors. The position will actively participate in MM Unit initiatives and programs and provide support to ensure the development of a fully integrated MM Unit within the Division of Managed Care Services, and in the evaluation, development, and implementation of Federal regulations and other AHCCCS initiatives.

Major duties and responsibilities include but are not limited to:

• Prepares and implements operating procedures in accordance with program rules and regulations, including but not limited to monitor compliance with State & Federal regulations pertaining to CM monitoring systems.
• Prepares and submits a variety of administrative and statistical reports for the monitoring and oversight of one or more specialized programs (e.g.: Over-Institutional Cost, ALTCS Transitional Program, Out-of-State Placements and Acute Care Only program). 

• Team Leader for Contractor Operational Reviews (ORs), focused reviews, 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. Coordinate & communicate with ALTCS Contractors to ensure the health and safety of AHCCCS ALTCS members.
• Establishes training courses for program participants and/or internal team/personnel. Provides technical assistance to Contractors and other personnel as needed. Will attend meetings and seminars related to the this position, as budget allows.
• Interpret and develop new/revise existing policies. Coordinate and lead internal and external policy workgroups
• Represent the MM Unit in internal and external meetings.
• Lead review and response of the annual CM Plan MCO submissions, with written correspondence outlining any deficiencies requiring corrective action.
• May serve in the absence of the CM Program Manager.
• Other duties as assigned as related to the position (typically 5% - 10%)

Knowledge, Skills & Abilities (KSAs):

Knowledge:
• Medicaid and Medicare Federal Regulations, State Statute and Rule and policies applicable to the ALTCS and other AHCCCS programs
• Common medical and psycho-social needs of individuals eligible for ALTCS
• Agency functions and inter-relation (i.e., AHCCCS, Center for Medicare and Medicaid Services [CMS], ADHS, DES/DDD, AHCCCS Health Plans, ALTCS Program Contractors and non-Medicaid disability and aging programs)
• ALTCS and AHCCCS program design and implementation, including case management functions and responsibilities, provider network and funding sources
• AHCCCS computer systems, Prepaid Medical Management Information System(PMMIS) and AHCCCS HEAplus, including Case management, Medical and Financial eligibility, Provider and Recipient subsystems