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.

Medical Management Supervisor

Division of Managed Care (DMC)

Job Location:

Address: 150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona.

Posting Details:

Salary: $72,000 - $78,650

Grade: 23

Position will remain open until filled.

Job Summary:

Under the general direction of the Medical Management Manager and Supervisor, this position will monitor and evaluate Medical Management programs for the AHCCCS Acute Care, Arizona Long Term Care System, and Integrated Behavioral Health Contractors.

Major duties and responsibilities include but are not limited to:
• Supervise, train and assist in the distribution of work assignments, work review, performance appraisal, hiring, etc.
• Write, implement, and review of the performance of the AHCCCS Acute Care and Arizona Long Term Care System Health Plans through the Operational and Financial Review process, including the corrective action plans. Technical assistance to Contractors as needed.
• Reviews and analyzes the data provided by Contractors/ Health Plans. Tracks compliance with the reporting of the Contractors / Health Plans per contract guidelines/policies or AHCCCS requests.
• Develop, update, review and interpret AHCCCS policies, rules and regulations, research changes and additions, identify potential issues, communicate impact of changes to division/agency management.
• Reviews, researches and assists in coordination of Transplant Activities for the Tribal Fee for Service members, and provides technical assistance to the Program Contractors/Health Plans regarding transplant policy. Interfaces and reviews compliance of contracted facilities in accordance with the AHCCCS facility contract. Identifies and reports to Manager any deficiencies with facility contract, including outcomes and gaps.
• Reviews Reinsurance medical records. Document findings and analyzes any trends and communicates trends orally and in writing to the Medical Management Manager.
• Communicates with internal and external (health plans/program contractors, members and providers) staff and respond to requests within the designated timeframes.
• Maintains active Catastrophic member list and is responsible for all written communication with the Contractor/ Health Plan regarding approval of members for Reinsurance. Reviews Reinsurance requests and applies medical criteria in the approval or need for Medical Director intervention on case approvals. Reports any untoward trends to the Medical Management Manager.
• Performs other duties as assigned by Manager, Division Assistant Directors or the AHCCCS Medical Director.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
• Principles and practices of Utilization Management
• Federal Regulations, State Statute, Rule, Policy and Procedure governing the AHCCCS program
• AHCCCS contractual arrangements with Health Plans and Program Contractors
• Management information system basic knowledge
• Computer system knowledge in Outlook, Word and Excel
• Health Care management principles and practice
• Current medical knowledge including evidence based medicine standards
• Techniques and methods of managing and supervising staff

Skills:
• Analytical and comprehension skills to interpret utilization management data within