Health Program Manager I

Salary: $65,000

Grade: 20

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Health Program Manager I. After extensive training, this position has the potential of being worked from home with some in office meetings. This position will be responsible for the delivery of special assistance to resolve quality of care issues involving behavioral health issues and those involving individuals with a serious mental illness (SMI) with an identified need (as defined by A.A.C. R9-21-104). After extensive training, this position has the potential of being worked from home with some in office meetings. This position is responsible for participating in the development, implementation, and monitoring of the quality care management functions, within the DHCM Clinical Quality Management Unit, other divisions with AHCCCS, and other state agencies.

* Receive, research, document, and resolve quality of care issues utilizing standardized processes and centralized databases. Track, trend, and monitor status of cases to ensure thorough and timely completion as well as appropriate referrals. Primary emphasis will be placed on special populations such as those utilizing behavioral health services. Ensure research and resolution of quality of care issues in a timely manner as assigned and identify systemic issues for AHCCCS to address.

* Participate in operational reviews, 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. Follow-up on written reports, corrective action plans, notices to cure and sanctions as appropriate.

* Ensure quality of care to AHCCCS members, including ensuring member health and safety as well as dignity and respect. Focus on unique aspects of each case, individual care needs, timely correspondence with members, and timely acknowledgment of concerns as well as resolution of the issue. Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.

* Coordinate and complete tracking, evaluation and responses to Contractor deliverables.

* Participate in special projects and reviews as assigned and assure completion within the designated timelines. Provide ongoing updates to leadership.

* Provide technical assistance to Contractors and FFS providers, as appropriate, regarding contractual and/or policy requirements to improve quality of care and service delivery to AHCCCS members.

* Participate in individual and ongoing meetings, including agendas, attainment of speakers, minutes and resulting actions and activities.

* Participate in the development of improved processes and procedures to improve efficiency of the QM Unit.

* Participate in peer review processes including presentation of challenging and high profile cases, and initiate resolution activities as directed by the AHCCCS Chief Medical Officer.

* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, Behavioral Health, LTC and Tribal and Childrens Rehabilitative Services

* Knowledge of current standards of medical/behavioral practice and modes of delivery for acute and non-acute medical/behavioral care/services.

* Techniques to select a particular approach to analyze develop or implement a policy, Project management methodologies and Behavioral Health delivery system.

* Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic backgrounds; project management to meet goals and deadlines.

* Skilled in nursing and clinical processes including assessment, planning, intervention, and evaluation.

* Ability to assess members from a holistic perspective with an emphasis on recognizing medical, social, environmental and emotional conditions, barriers for meeting medical needs that interfere with the member's ability to function at an optimal level

* Communicate orally and in writing with members and their RBHA provider to facilitate resolution or presenting issues.

* Ability to work in a virtual environment.

* Certified Professional in Healthcare Quality.

* At least one year professional healthcare industry experience in Quality or Utilization Management or two years of experience in the behavioral health field, preferably in the context of the delivery of service in Arizonas public behavioral health system.

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.