AHCCCS

Arizona Health Care Cost Containment System
Accountability Community Innovation Leadership Passion Quality Respect Courage Teamwork

The Arizona Health Care Cost Containment System (AHCCCS) Arizonas Medicaid agency is driven by its mission to deliver comprehensive costeffective 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 entrylevel positions and internship opportunities AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Phoenix 801 E. Jefferson Street Phoenix AZ 85034

Tucson 7202 East Rosewood Street Suite 125
Tucson Arizona 85710

This position may offer the ability to work remotely within Arizona based upon the departments needs and continual meeting of expected performance measures.

Salary: $72132

Grade: 22

Closing Date: Open until filled

This position will work independently applying clinical knowledge judgment and expertise to assess coordinate and monitor service delivery. This position will complete comprehensive assessments of available resources on service providers and individual members; review case material to ensure compliance with State and Federal regulations and policies; and provide timely resolution of multiple cases assigned. This position will also be responsible for identifying systemic issues for AHCCCS to address. This position will be hybrid with some inoffice meetings onsite investigations and reviews as needed. Occasionally this position may also participate as needed in urgent onsite investigations and reviews outside of normal business hours and weekends.

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 States 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.

Major duties and responsibilities include but are not limited to:
Monitor compliance with State and Federal regulations pertaining to quality management processes tracking and trending quality of care concerns and/or health and safety/immediate jeopardy concerns. Receive research document and resolve quality of care and/or health and safety issues utilizing standardized processes. Track trend and monitor the status of cases to ensure accurate and timely completion and appropriate referrals using a centralized case management tracking database. Ensure research and resolution of issues or concerns promptly as assigned and identify systemic issues for AHCCCS to address.
Contributes clinical knowledge to assist in the resolution of quality of care concerns clinical reviews and Operational Reviews. Completes an independent review of data management and other deliverables technical assistance and focused studies/reviews including the behavioral health delivery system to ensure compliance with contractual and policy requirements for all lines of business. Followup on written reports action plans provider education and related actions as appropriate.
Ensure quality of care to AHCCCS members including ensuring member dignity and respect focused on their unique special health care needs timely correspondence and resolution of the quality of care concern. Use independent judgment regarding data to research status level interventions and appropriate resolution.
Conduct onsite investigations regarding possible health and safety concerns immediate jeopardy situations and other situations supporting AHCCCS initiatives and ventures. Onsite visits may also occur outside of normal business hours and weekends for immediate and urgent situations.
Develop improved processes and procedures to improve the efficiency of the unit. Lead special projects and reviews to ensure completion within the designated timelines. Provide ongoing updates to Management.
Develop metrics for populationspecific outcome objectives. Tracking evaluation analysis and revision of metrics as needed based on the ongoing analysis of member data.
Provide education and technical assistance to internal and external stakeholders as appropriate regarding covered services and contractual or policy requirements accurately and consistently to improve compliance with AHCCCS requirements and improve quality of care and service to AHCCCS members.

Knowledge of:
State and Federal Policies and Procedures governing Title XIX Title XXI Managed Care and LTC Supports and Services
Current standards of medical/ behavioral practice and modes of delivery for acute and nonacute medical/behavioral care/services
Data management and utilization review regulations rules and processes
AHCCCS and Medicaid regulations policies and procedures and applicable federal and state statutes regulations and rules
Medical/nursing practice medical case management protocols utilization review protocols as related to the acute LTC chronic longterm elderly and physically disabled developmentally disabled and behavioral/mental health
Case management development implementation and ongoing review

Skill in:
Acute nursing and clinical processes including assessment planning intervention and evaluation
Clinical assessment skill
Techniques to select a particular approach to analyze develop or implement a policy project management methodologies and Behavioral Health delivery system
Problemsolving techniques evaluation and initiation of appropriate action
Excellent communication verbal and written
Organizational skills for setting priorities workload and recordkeeping
Strong interpersonal skills in working with agency management and people of diverse cultures and socioeconomic backgrounds
Project management to meet goals and deadlines
Research and analytical skills
Documentation and reporting of data and trends

Ability to:
Strong ability to collaborate with others for a mutually beneficial outcome
Interpret clinical information and assess implications for treatment
Read interpret and apply complex rules and regulations
Independent decision making yet knowing when to elevate an issue or concern
Assess variables which impact health and functioning
Make effective decisions in a high volume fast paced environment
Write comprehensive reports

Arizona Drivers License

Minimum Qualification: Possession of a current license to practice as a registered nurse in the State of Arizona and three 3 years of relevant healthcare experience.

Preferred Qualification: At least one year experience working in a managed care environment. Case Management Quality Management Utilization Management and/or social work experience. Certified Professional in Healthcare Quality or case management certification.

Successfully pass fingerprint background check prior employment verifications and reference checks; employment is contingent upon completion of the abovementioned process and the agencys 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 R210207.12. 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:Drivers License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (EVerify).

Among the many benefits of a career with the State of Arizona there are:
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 parttime employees)
Paid Parental LeaveUp to 12 weeks per year paid leave for newborn or newlyplaced foster/adopted child (pilot program).
Other Leaves Bereavement civic duty and military.
A topranked 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

By providing the option of a fulltime or parttime 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 programhere. For a complete list of benefits provided by The State of Arizona please visit our benefits page

Lifetime Pension Benefit Program
Administered through the Arizona State Retirement System (ASRS)
Defined benefit plan that provides for lifelong income upon retirement.
Required participation for LongTerm Disability (LTD) and ASRS Retirement plan.
Pretaxed payroll contributions begin after a 27week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
Voluntary participation.
Program administered through Nationwide.
Taxdeferred retirement investments through payroll deductions.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.