Public Healthcare Consultant

Arizona Department of Administration • Phoenix, AZ

1d • $71,032 • 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. The Division of Managed Care (DMC) is looking for a highly motivated individual to join our team as a Maternal Child Health (MCH) Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Coordinator. Under the leadership of the MCH EPSDT Program Manager, this position provides oversight of the EPSDT, women’s preventive health, family planning, and maternity care services within AHCCCS’s statewide managed care and fee for-service programs. This role ensures services that support pregnant and postpartum members; infants and children are delivered in compliance with state and federal requirements. This position is responsible for quality improvement activities, validating deliverables, identifying gaps and recommending strategies to improve performance.

Requirements

• State and Federal rules, regulations, policies and procedures governing Title XIX, Title XXI, Managed Care, and LTC and Tribal lines of business
• Medical/nursing practice, medical case management protocols, quality management and utilization review protocols as related to the all populations including maternal and child health services, women's preventive health, family planning services and supplies, EPSDT, acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, behavioral/mental health, children in the foster care system and Tribal lines of business
• Current quality improvement and health care theories and practices
• Background in and knowledge of quality management principles and accreditation bodies’ review processes
• Organizational skills for setting priorities, workload, and record keeping
• Project management to meet goals and deadlines
• Public speaking and delivering presentations or technical assistance to internal and external stakeholders
• Written communication and correspondence with internal and external stakeholders
• Problem-solving techniques, evaluation, and initiation of appropriate action
• Research and analytical skills
• Interpret and apply rules, regulations, and policies to MCH EPSDT program operations and oversight activities
• Interpret clinical information
• Develop, implement and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, Sister Agency and/or tribal Contractor's
• Manage multiple priorities effectively
• Lead special projects
• Collaborate with internal and external stakeholders
• Identify gaps and recommend solutions
• Must maintain a current Arizona medical license (RN or higher) or Arizona Behavioral Health license (Associate or higher) and 3 years of relevant healthcare experience.
• May require a valid Arizona Driver License for travel-related duties.

Nice To Haves

• Experience in Prior Authorization, Utilization Management, claims review, auditing, or managed care; knowledge of population served.

Responsibilities

• Oversight and monitoring of EPSDT, women’s preventive health, family planning, and maternity care programs to ensure state and federal requirements are met.
• Participate in operational reviews, administrative reviews, technical assistance, and focused studies/reviews to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, corrective action plans and other compliance actions as appropriate.
• Represent the MCH EPSDT Unit in the development and revision of contracts, amendments and policy. This position may participate in work groups, steering teams, and scoring teams as needed and requested by the agency.
• Provide education and technical assistance to internal and external stakeholders, including Contractor's and FFS providers, as appropriate regarding covered services, and contractual or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve EPSDT and maternal child health services to AHCCCS members. Includes identification, research and resolution of issues as needed.
• Collaborate with other AHCCCS units and state and local health and social service agencies, including ADHS, DES/DDD, DCS, Head Start, Vaccines for Children (VFC), childhood blood lead prevention program etc. as well as community and private health care providers.
• Coordinate and complete tracking, evaluation, and responses to Contractor deliverables such as annual program plans and member materials, to assure MCH EPSDT components are thoroughly addressed and align with policies.
• Lead special projects and reviews to ensure completion within the designated timelines and alignment with current recommendations. Provide ongoing updates to Management.

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