AHCCCS

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

All AHCCCS Employees must reside within the state of Arizona.

Salary: $62,000 - $67,000

Grade: 22

Position will remain open until filled.

Under the leadership of the Case Management (CM) Manager, this position will provide oversight of the Pre-Admission Screening and Resident Review (PASRR) Program. This position will ensure that the PASRR Program is operated in alignment with Federal and State rules and regulations. The position will supervise two PASRR staff positions, overseeing the PASRR Level I and Level II reviews and provider/MCO/stakeholder training efforts related to PASRR. This position will review program data, identify risks/trends/opportunities, and implement/oversee processes that ensure timely and accurate evaluations of individuals that are being admitted into institutional settings across the state as well as update internal/external policies/procedures as necessary to promote compliance.
The position will actively participate in CM Unit initiatives and programs and provide support to ensure the development of a fully integrated CM Unit within the ALTCS team and the Division of Managed Care. This position will engage in broader program and delivery system efforts as needed, support case management and ALTCS delivery system efforts when appropriate, and will lead evaluation, development, and implementation of applicable Federal/state regulations and other AHCCCS initiatives with support from the CM Manager.

Major duties and responsibilities include but are not limited to:
• Prepares, implements, and evaluates implementation of operating procedures in accordance with Program rules and regulations, including but not limited to monitor compliance with State & Federal regulations pertaining to PASRR as well as audits of staff work related to Level I and Level II submission reviews/evaluations
• Lead development and monitoring of the program policies and procedures, including performance audits to ensure conformance with federal and state laws, and all legal mandates. Lead contract and policy updates pertaining to PASRR program as needed. Interpret and develop new/revise existing policies. Will attend meetings and seminars related to this position, as budget allows.
• Represent the PASRR team and CM Unit in internal and external meetings. Attend meeting with ISD to support PASRR Portal operations, improvements, and/or issue resolution. Lead content development and oversee training efforts related to PASRR (either from PASRR staff and/or use of a vendor when need arises/budget allows).
• Prepares and submits a variety of administrative and statistical reports for the monitoring and oversight on areas of interest related to the PASRR Program (e.g volume of submissions, accuracy evaluations, timeliness of reviews, Level II dispositions) Team Leader for MCO PASRR audits and focused reviews, to evaluate the effectiveness of submitted documentation and to improve processes and delivery of quality care.
• Manage and direct subordinate staff (work assignments, setting priorities, hiring, discipline, provide training, approving leave requests, and preparing evaluations). Review direct staff's position descriptions and update as needed. May serve in the absence of the CM Manager to support the broader team.
• Receive and review payment requests for Level I Screenings and Level II evaluations. Ensure comprehensive documentation and monitor for budget impacts and/or unexpected trends related to PASRR expenses.
• Participate in regional and/or national PASRR education webinars. Stay apprised of federal policy updates related to PASRR and adjust Program as needed to align. Will attend meetings and seminars related to this position, as budget allows.
• Participate and federal/state audits of the PASRR program and lead development of responses back to auditing entities (e.g. HHS OIG).

Knowledge:
• Medicaid and Medicare Federal Regulations, State Statute and Rule and policies applicable to PASRR, ALTCS and other AHCCCS programs
• Common medical and behavioral health needs of individuals needing an institutional level of care
• Agency functions and inter-relation (i.e., AHCCCS, Center for Medicare and Medicaid Services [CMS], ADHS, DES/DDD, AHCCCS Health Plans, ALTCS Program Contractors and non-Medicaid disability and aging programs)
• PASRR program design and implementation, including evaluation functions and responsibilities, provider supports, and funding sources
• AHCCCS computer systems, Prepaid Medical Management Information System(PMMIS) and AHCCCS HEAplus, including Case management, Medical and Financial eligibility, Provider and Recipient subsystems, PASRR Portal

Skills:
• Reviewing case documentation in order to evaluate the appropriateness of placements and services for ALTCS members
• Interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds and those in crisis
• Oral and written communication, including writing reports and general correspondence
• Presentation skills in order to provide technical assistance and training to contractors and staff
• Time management and initiative, with ability to work with little or no supervision
• Microsoft Office (Word, Excel, PowerPoint, Outlook) or comparable software program
• Organization and prioritization of multiple tasks and ability to re-prioritize as necessary
• Program monitoring and auditing
• Identifying trends, risks, or opportunities to improve performance/compliance

Abilities:
• Collect, review and analyze data, identify trends and develop plans and methods for program improvement
• Recognize cause and effect in identified areas of non-compliance; evaluate program performance and resolve problems of non-compliance
• Communicate program compliance findings in an objective, non-threatening way to contractors and providers
• Read, interpret and apply complex rules and regulations
• Effectively problem solve issues as they arise
• Engage staff and provide constructive feedback on work assignments

Minimum:
• Four years professional experience related to health programs and/or behavioral health evaluation appropriate to the assignment, which includes program planning or administration; a Bachelor’s degree in a field appropriate to the assignment may substitute for one year of the required experience.

Preferred:
• Bachelor's Degree in Social Work or other related healthcare field.

• One or more years working in a managed care environment.

• One or more years of supervisory 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.

• 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.