Responsible for management and oversight of the AHCCCS Division of Managed Care Provider Network unit, ensuring managed care health plan provider network sufficiency and access to care for members. Participate as a lead role in the development of provider network standards and guidelines.
Major duties and responsibilities include but are not limited to:
• Conduct ongoing assessments and monitoring of provider network sufficiency for managed care enrollees. Assessing provider network sufficiency including capacity analysis, development of provider network standards, oversight of deliverables, quality management and process improvement, including changes to provider networks and provider closures.
• Develop provider network standards and guidelines for provider network adequacy and performance including timeliness, distance, measures of engagement, and quantifications of provider supply for key specialization to ensure access to care for our managed care enrollees and compliance with Federal regulations.
• Oversee and ensure quality of health plan provider network deliverables, corrective action plans, and responses to provider network issues, including management and oversight of the Provider Affiliation Transmission files.
• Development of provider network surveys and/or secret shopper or other monitoring procedures.
• Examine multiple quantitative and qualitative data sets, including utilization of data, eligibility/enrollment, penetration, complaints, and customer satisfaction.
• Ensuring compliance with Federal Managed Care Regulations as they relate to provider network requirements.
• Collaborate and facilitate meetings with groups of internal and external stakeholders, scheduled, ad hoc and technical assistance.
• Participate in development and evaluation of managed care requests for proposals.
• Participate in evaluating and overseeing the readiness of new managed care contracts.
• Managing direct reports in relation to work assignments, work reviews, performance reviews, leave requests, hiring, and disciplinary actions.
• Developing contract and policy requirements and language related to managed care organization and provider network oversight.
• Conduct assessment of provider network sufficiency, performance, analysis, of provider networks in light of policies changes made related to fraud, waste, and abuse activities.
Knowledge:
• Provider Network Planning, development, and monitoring
• Behavioral health, long term care, and physical health service delivery system and operations
• Licensure regulations
• State Medicaid agency regulations
• Managed care concepts
• Data analysis, interpretations, and reporting
• Interpersonal communication/conflict resolution process
• Project management
• Lean management principles
Skills:
• Strong interpersonal skills to effectively relate to members and/or their families, multidisciplinary professionals, contractor representatives, and stakeholders
• Analytical and decision making skills
• Problem solving and trouble shooting skills
• Group facilitation and project management skills
• Information collection and synthesis skills
Abilities:
• Assess provider network sufficiency through a holistic perspective with emphasis on medical, social, environmental conditions and barriers for meeting unique needs
• Communicate effectively both orally and in writing within all levels of the organization
• Exercise initiative, judgment, problem solving, and decision making
• Establish and maintain cooperative working relationships with senior management
• Research and prepare comprehensive reports
• Organize work to achieve goals and objectives
Minimum:
• Three years of experience in healthcare and/or project management.
Preferred:
• Bachelor's degree in Business or Healthcare Management and 5 years experience in healthcare and/or project management. Project Management Certification preferred.
• 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.) 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: 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 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.