AHCCCS

Address: 801 E. Jefferson Street, Phoenix, AZ 85034

All AHCCCS Employees must reside within the state of Arizona.

Salary: $85,000 - $90,000

Grade: 25

Position will remain open until filled.

There are two major areas of focus within this unit – case management (CM) and the Pre Admission Screening and Resident Review (PASRR) program. This position is responsible for effective program development, management and oversight of the ALTCS case management program and related care/services delivery to members served by the ALTCS Managed Care Organizations (MCOs).

This position providers leadership to the teams that are responsible for ongoing oversight of the MCOs that serve ALTCS members (both aging/those living with physical disabilities and individuals with intellectual/developmental disability diagnoses, including members with serious mental illness and other behavioral health needs).

This position leads extensive internal and external engagement to support members through development/maintenance of an effective ALTCS program centered around member-specific needs and effective case management strategies. Additionally, this position leads comprehensive delivery system monitoring related to member access to HCBS and institutional care, functional assessments of need, person-centered service planning, and ensures compliance with numerous aspects of federal/state requirements related to ALTCS services.

This position is responsible for drafting, implementing, and refining ALTCS-related policies and well as ensuring adherence to ALTCS-related contract and policy requirements (in collaboration with the AHCCCS Tribal ALTCS staff).
This position also works with numerous providers to ensure adherence to the PASRR program and related assessment needs of members who have institutional level of care needs. This manager position reported to the Deputy Assistant Director of ALTCS within the Division of Managed Care.

Major duties and responsibilities include but are not limited to:
• Ensure ongoing case management compliance by the ALTCS MCOs (case management service reviews, data reports, performance reports, operational reviews, and correction actions). Maintains regulatory active oversight of the ALTCS MCOs, including DDD Staff complex cases with MCOs and provide system navigation supports either directly or through coordination with MM or CRU. Collaborates with DFSM on the ALTCS Tribal Program and provide support re: federal regulations/oversight requirements. Ensure DFSM engagement in policy/program update efforts.
• Ensure ongoing oversight of specialized programs, including but not limited to Behavioral Health Reinsurance, Out-of-State placements and the federally mandated Pre-Admission Screen and Annual Resident Review (PASRR) program. Support provider questions regarding these efforts and work with ISD to maintain electronic systems for submission
• Develops programs, initiatives, processes, and improvements/maintains quality care coordination, case management, behavioral health services, home and community based services, disease management and healthcare education for ALTCS members. Oversees effectiveness of MCO-based case management programs in supporting members. Review data related to all these efforts and use to drive improvements to delivery system. Provide updates to leadership and stakeholders as appropriate and collaborate on ongoing performance improvements. Attend site visits as appropriate to evaluate program opportunities/member engagement efforts.
• Maintain accurate and up to date case management policy. This includes collaboration with internal and external teams to develop, maintain and monitor the polices for an effective program. Provide technical assistance and ongoing training to ALTCS MCOs, which may include direct training and/or train the trainer efforts for major updates. Engage stakeholders and be responsive to feedback. Audit compliance with policy and broader ALTCS programming requirements as appropriate.
• Supervises, directs activities, and monitors/evaluates staff. Implement AMS and other required supports for team (e.g. 1:1s, coaching, professional development). Provide support to team members, Provide ongoing feedback and support. Help implement vision of agency/division to ensure alignment/engagement of team. Review direct staff's position descriptions and update as needed.
• In collaboration with the AHCCCS Information Services Division maintains the "CATS" system so that case management information is collected from the contractors and that accurate reports can be produced. Work with ISD on system updates and/or modernization of systems that support engagement with MCOs/providers on ALTCS-related issues. Ensure users are kept up to date and engaged in testing/training as changes are made.

Knowledge:
• Methods to develop, administer and oversee the ALTCS case management program
• The population served by the ALTCS program (elderly, physically disabled, and developmentally disabled and their service needs)
• Medicaid and Medicare Federal Regulations, State Statute and Rule and policies applicable to the ALTCS and other AHCCCS programs, managed care concepts and practices
• How specific agencies function and inter- relate
• ALTCS and AHCCCS program design and implementation, including case management function and responsibilities, provider network and funding sources
• AHCCCS computer systems
• Community resources relative to providers of service to AHCCCS and ALTCS clients, basic knowledge of Third Party Liability process
• Native American Tribes/programs and ALTCS policy relative to Inter-Governmental Agreements and related policies
• Techniques to select a particular approach to analyze, develop, or implement a policy
• Techniques to select a particular approach to design and administer an operational analysis method
• Decision-making techniques of setting ALTCS case management priorities
• Person-centered service planning and related techniques
• Home and community based services and related care planning

Skills:
• Analysis, evaluation and resolution of complex problems
• Excellent interpersonal skills with individuals as well as large groups
• Effectively collaborating with people in positions on all levels.
• Effectively leading and/or facilitating a team of professionals from within and/or outside the agency
• Producing effective written communication
• Conflict research and resolution
• Analytical skills to identify issues and present recommendations
• Documentation re: member care and all efforts related to case management
• Data review and evaluation for trends/risks impacting populations served.
• Project management to meet goals and deadlines
• Computer software (e.g., word processing, spreadsheets, databases)
• Supervision and team engagement

Abilities:
• Represent AHCCCS effectively both internally and externally
• Work independently and make decisions within defined scope
• Collaborate with others to achieve compliance as well as supportive, member- centered programming.
• Effectively manage multiple priorities/ projects in a fast paced environment
• Understand the unique characteristics and experiences of individuals engaged in the ALTCS program
• Develop programs/initiatives to enhance case management efforts and support member access to all aspects of medically necessary care/services
• Evaluate program performance and make adjustments to achieve desired outcomes
• Producing work products with limited supervision

Arizona Driver's License.

Minimum:
• Five years of professional experience related to health program case management AND two plus years of supervisory experience.

Preferred:
• Masters degree in Social Work, Nursing, Public Administration, or Public Health.

• 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.)

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).

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 part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here.
• 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

By 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. 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 life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred 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 careers@azahcccs.gov.

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.