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.

Network Administrator

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: $82,500 - $88,500

Grade: 23

FLSA Status: Exempt

This position will remain open until filled.

Job Summary:

Responsible for management and oversight of the AHCCCS Division of Managed Care Provider Network unit, ensuring managed care health plan provider network sufficiency and access to care for members. Participate as a lead role in the development of provider network standards and guidelines.  

Major duties and responsibilities include but are not limited to:  
• Conduct ongoing assessments and monitoring of provider network sufficiency for managed care enrollees. Assessing provider network sufficiency including capacity analysis, development of provider network standards, oversight of deliverables, quality management and process improvement, including changes to provider networks and provider closures. 

• Develop provider network standards and guidelines for provider network adequacy and performance including timeliness, distance, measures of engagement, and quantifications of provider supply for key specialization to ensure access to care for our managed care enrollees and compliance with Federal regulations. 

• Oversee and ensure quality of health plan provider network deliverables, corrective action plans, and responses to provider network issues, including management and oversight of the Provider Affiliation Transmission files. 

• Development of provider network surveys and/or secret shopper or other monitoring procedures. 

• Examine multiple quantitative and qualitative data sets, including utilization of data, eligibility/enrollment, penetration, complaints, and customer satisfaction. 

• Ensuring compliance with Federal Managed Care Regulations as they relate to provider network requirements. 

• Collaborate and facilitate meetings with groups of internal and external stakeholders, scheduled, ad hoc and technical assistance.

• Participate in development and evaluation of managed care requests for proposals. 

• Participate in evaluating and overseeing the readiness of new managed care contracts.

• Managing direct reports in relation to work assignments, work reviews, performance reviews, leave requests, hiring, and disciplinary actions. 

• Developing contract and policy requirements and language related to managed care organization and provider network oversight. 

• Conduct assessment of provider network sufficiency, performance, analysis, of provider networks in light of policies changes made related to fraud, waste, and abuse activities.

Knowledge, Skills & Abilities (KSAs):

Knowledge: