AHCCCS

This position serves as a technical and analytical lead responsible for monitoring, auditing, and evaluating ALTCS program and MCO performance. The role develops data strategies, reports, dashboards, and audit methodologies to identify trends, risks, compliance concerns, and performance outliers across a variety of program areas, while validating data accuracy and reliability. Working closely with data teams and program subject matter experts, the position analyzes complex datasets, develops monitoring tools, evaluates program effectiveness, and implements proactive oversight strategies that support program integrity, policy compliance, and the quality of services provided to ALTCS members. It also ensures the secure and appropriate use of sensitive data and supports data-driven decision-making through advanced reporting and statistical analysis.

Major duties and responsibilities include but are not limited to:
• Lead the development of complex, multi-factorial audit strategies for numerous areas of the ALTCS program, including creation and testing of appropriate methodologies, monitoring implementation, and analyzing data captured during the audit process. Monitor, facilitate coordination and/or refine/update tracking criteria, and address questions and concerns related to current dashboards and program monitoring efforts across various programs/units; flag any observed risks and/or data abnormalities for ALTCS, division, and agency leadership review. Maintain mindfulness of the vulnerabilities of the ALTCS population, the sensitive nature of the data, and the high visibility of program outcomes at both the state and federal levels.
• Responsible for submission of new data requests to ISD, analyzing data reports and developing digestible/actionable monitoring tools, and leading a regular cadence of data review meetings for each team where metrics are being monitored. Build out internal-facing ALTCS “dashboards” for specific areas of interest (e.g. members with Alzheimer's/dementia, longitudinal ALF and NF utilization, members with a TBI). Support agency program integrity efforts in coordination with OIG and in alignment with federal priorities and/or findings from federal or state audits.
• Develop and implement methods to audit against MCO self-reported data and/or federal/state-specific data from external sources (e.g. comparison of state or federal data to MCO-specific information). Develop and/or refine methods of MCO-to-MCO comparisons and evaluation. Lead teams in identifying areas of risk, trend identification, and/or future projects related to micro and macro aspects of populations served; educate teams on how to best engage in programmatic monitoring and ensure bi-directional flow of information, data, and related processes.
• Work with other units to support broader efforts re: MCO oversight and population management (e.g. QI, QM, DMPS, ISD AODA, DMC Clinical and Ops teams). Work with OIG to better understand risks/trends to enhance monitoring and oversight efforts.
• Implement data-related improvements and/or monitoring efforts based on results of the NCI-AD survey, Federal Rule requirements (e.g. Access Rule, Managed Care Rule), and/or state or federal audits (e.g. PPCG audit). Provide documentation of efforts as needed to respond to federal or state audits, as appropriate, to maintain and/or document compliance with federal and state laws/regulations.

Knowledge:
• Principles, methods, or tools for developing, scheduling, coordinating, and managing projects and resources
• Health care industry, Arizona Long Term Care System (ALTCS) and managed care concepts and practices as well as obtaining knowledge of AHCCCS contracts and policies and the behavioral health delivery system in Arizona
• State and federal health care laws and regulations
• Theoretical and practical concepts of the health care market, State government organizations, operations, processes, and procedures, especially those related to program monitoring
• Concepts and techniques associated with program evaluation, auditing, and regulatory oversight
• Various types of data structures and forms

Skills:
• Data analytics
• Manipulating large data sets to highlight relevant information in a digestible format
• Developing detailed data requests
• Developing guidelines/structures for ad hoc program audits
• Development of program auditing/monitoring strategies and implementation of these strategies
• Producing written information in a succinct and organized manner that is appropriate for intended audience(s)
• Implementing/refining monitoring tools to support effective oversight
• Effective communication, presentation, and research skills
• Translating business needs to technical specifications and evaluating related inputs/outputs
• Auditing multiple deliverables or data sets and determining accuracy/compliance

Abilities:
• Work independently and be self-motivated
• Interact, influence, and motivate internal and external stakeholders effectively to obtain pertinent information for decision making and to communicate directly and effectively
• Effectively analyze data, identify risks, and develop responsive strategies to address as well as provide ongoing monitoring for sustainable improvements
• Efficiently move projects forward meeting expected timelines
• Develop and maintain effective working relationships
• Effectively work with community advocacy and stakeholder groups
• Manage multiple, high priority projects simultaneously
• Design easily understandable data displays (e.g. charts, graphs, pivot tables) based off of raw data
• Manage multiple audit strategies with competing priorities/timelines and effectively provide updates on each strategy as needed

Minimum:
• Two years of management analysis experience appropriate to the assignment; OR four years of experience appropriate to the assignment; A Bachelor's or Master's degree in a field appropriate to the assignment will substitute for one or two years of the required experience respectively, but will not substitute for the management analysis experience.

Preferred:
• Experience with insurance, healthcare claims, contract compliance, auditing, legal environment, Medicaid agency or Medicaid contractor. Project Management Certification and/or Six Sigma Green or Black Belt Certification.

• 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.