Job Summary :
This position will be responsible for Participating in the ORs to assess compliance with AHCCCS’ CM standards for ALTCS Contractors, addressing inquiries, providing resources, and taking concerns from external customers including members, providers, families, the community and other agencies and stakeholders and ensuring timely and appropriate resolution of complaints. Monitoring and resolution of member specific and policy related issues at the ALTCS Contractor level, monitoring member participation in and / or Contractor compliance with specialized programs-specifically Out of State Placements, Transitional Program, Over Institutional Costs, and the Acute Care Only programs.
Participate in the evaluation, development, and implementation of Federal regulations and other AHCCCS initiatives, review of the annual CM Plans submitted by Contractors for compliance with the contract and policy and the development and oversight of any resultant corrective action, review and interpret policy pertaining to CM, review and analysis of reports and Contractor specific data.
Providing ongoing support and technical assistance to ALTCS Contractors, coordinating the planning, preparation, and facilitation of Quarterly ALTCS Case Management Contractor meetings. Representing the MM Unit in internal and external meetings, interface with other functional units within AHCCCS as needed in order to accomplish the agency’s mission and provide back-up coverage for the PASRR Coordinator, as needed.
Major duties and responsibilities include but are not limited to :
- Prepares for and participates in the Operational Reviews to include the review of pre-audit documents and policies, on site audit, formal written documentation of findings, and monitoring the Corrective Action Plans as applicable.
- Independently monitors one or more specialized programs, such as Over-Institutional Cost, ALTCS Transitional Program, Out-of-State Placements and Acute Care Only program.
- Investigates and responds to member and / or policy related issues with ALTCS Contractors.
- Provides training and technical assistance to Contractors and other personnel as needed.
- Reviews, interprets, and revises policies.
- Represent the MM Unit in internal and external meetings.
- Review of the annual CM Plan for each Contractor along with written communication outlining any deficiencies that need to be corrected.
- Participates in the preparation and facilitation of Quarterly ALTCS Case Management meetings.
Knowledge, Skills & Abilities (KSAs) :
Knowledge :
Medicaid and Medicare Federal Regulations, State Statute and Rule and policies applicable to the ALTCS and other AHCCCS programsCommon medical and psycho-social needs of individuals eligible for ALTCSHow specific agencies function and inter- relate (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 sourcesAHCCCS’ computer systems, Prepaid Medical Management Information System (PMMIS) and AHCCCS HEAplus, including Case management, Medical and Financial eligibility, Provider and Recipient subsystemsCommunity resources relative to providers of service to AHCCCS and ALTCS clientsSkills :
Reviewing case documentation in order to evaluate the appropriateness of placements and services for ALTCS membersInterpersonal skills in working with people of diverse cultures and socioeconomic backgrounds and those in crisisOral and written communication, including writing of reports and general correspondencePresentation skills in order to provide technical assistance and training to contractors and staffTime management and initiative, with ability to work with little or no supervisionOrganization and prioritization of multiple tasks and ability to re-prioritize as necessaryUse of Microsoft products including Word, Excel, Access Database and PowerPoint, as well as Google applications, and the ability to learn new computer applicationsAbilities :
Assess members from a holistic perspective and psycho-social emphasis, recognizing medical, environmental and emotional conditions or barriers that interfere with the member’s ability to function at his / her highest level of independenceCollect, review and analyze data, identify trends and develop plans and methods for program improvementRecognize cause and effect in identified areas of non-compliance and recommend solutionsCommunicate program compliance findings in objective, non-threatening way to contractors and providersRead, interpret and apply complex rules and regulationsWork from a Virtual Office (VO) settingQualifications : Minimum :
Three years of professional experience related to health programs appropriate to the assignment, which included program planning or administration. (A Master's degree in a field appropriate to the assignment may substitute for one year of the required experience.)Preferred :
Bachelor’s degree in Social Work or other related healthcare field.Pre-Employment Requirements :
Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply : Driver’s License Requirements.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
Benefits :
Among the many benefits of a career with the State of Arizona, there are :
10 paid holidays per yearPaid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster / adopted child (pilot program).Other Leaves - Bereavement, civic duty, and military.A top-ranked retirement program with lifetime pension benefitsA robust and affordable insurance plan, including medical, dental, life, and disability insuranceParticipation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)RideShare and Public Transit SubsidyA variety of learning and career development opportunitiesBy providing the option of a full-time or part-time remote work schedule, employees enjoy improved work / life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
Learn more about the Paid Parental Leave pilot program here.
