Health Program Manager 1

Arizona Department of Administration • Phoenix, AZ

16h • Hybrid

About The Position

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 1 Division of Managed Care (DMC) Job Location: Address: 150 North 18th Avenue Phoenix, Arizona 85007 Posting Details: Must Reside in Arizona. Salary: Up to $55,000 Grade: 20 FLSA Status: Exempt This position will remain open until filled. This position may offer the ability to work remotely, within Arizona, based upon the agency’s business needs and continual meeting of expected performance measures. Job Summary: The purpose of this position is to implement the Pre-admission Screening and Resident Review (PASRR) program for Arizona residents admitted to a skilled nursing facility. This position is responsible for coordinating and evaluating Level I and Level II PASRR submissions to ensure compliance with Federal and State rules and regulations related to PASRR. This position audits submissions for accuracy and completeness and utilizes clinical judgment to evaluate decisions made by submitting providers and ensures that Level II requests are processed in accordance with policies and reviewed timely by the third-party clinicians. 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.

Requirements

• Two years of professional experience related to health programs appropriate to the assignment.
• Associates degree in a field appropriate to the assignment may substitute for one year of the required experience.
• 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.
• All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Nice To Haves

• Bachelor's degree a healthcare related field and/or 2-3 years of work experience related in Analytics, Auditing, Health Care, or Behavioral Health.
• Strong computer skills, understanding of State and Federal policies and procedures governing Medicaid and Medicare and knowledge of PASRR policies and procedures.

Responsibilities

• Coordinate and monitor the processing of PASRR referrals and evaluations.
• Use clinical judgement to evaluate the accuracy and completeness of Level I and Level II submissions as well as to determine which third-party reviewer is best suited to address Level II submissions (behavioral health professional or intellectual/developmental disability professional).
• Maintain the PASRR mailbox/Portal and update the PASRR database to monitor and track clients.
• Provide support to providers by addressing inquiries and/or connecting providers with ISD or other appropriate resources.
• Resolve discrepancies and provide general problem solving efforts regarding the PASRR program (e.g. concerns, appeals, grievances.
• Assist with development and monitoring of the program policies and procedures, including performance audits to ensure conformance with federal and state laws, and all legal mandates.
• Support training initiatives and provide technical assistance to internal staff, MCOs and providers as needed.
• Interpret Federal and State rules and regulations.
• Maintain client records and referrals.
• Attend meetings, seminars and conferences related to program.
• Other duties as assigned as related to the position (typically 5% - 10%)

Benefits

• 10 paid holidays per year
• Paid 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.
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree