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

Salary: $140,000 - $150,000 

Grade: E4

Closing Date: Open until filled

This position is a member of the AHCCCS Leadership Team and leads the Division of Fee for Service Management (DFSM), which is responsible for administering the American Indian Health Program (AIHP) as well as other AHCCCS fee for service (FFS) programs (e.g. Federal Emergency Services (FES), School Based Claiming). This position directly supervises and directs the DFSM Leadership Team to execute their responsibilities of both the administrative (e.g. claims processing) and clinical (e.g. member care coordination, onsite quality monitoring) functions of DFSM. This position reports to the DFSM Assistant Deputy Director. DFSM is the third largest health program in the AHCCCS Program. In addition to administering AIHP, FES, and School Based Claiming FFS programs, DFSM also acts as a Third Party Administrator (TPA) for Arizona State and County Departments of Corrections to reimburse services for eligible members.

DFSM core functions include:
• AIHP member care management, including coordination with Indian Health Services (IHS) and 638 facilities
• AIHP member quality of health care services monitoring, including coordination of routine provider onsite quality of care visits and in response to quality of care concerns
• Manage all DFSM contracts, including the pharmacy benefits manager (PBM); Tribal Regional Behavioral Authority (TRBHA) agreements with Navajo Nation, White Mountain Apache, Pascua Yaqui, and Gila River; and utilization/medical management with Health Services Advisory Group (HSAG)
• Management and oversight of Tribal 638 facilities, TRBHAs, Tribal ALTCS, and American Indian Medical Home (AIMH)
• Electronic and paper claims processing, including coordinating system edits and utilization data trend analysis with the AHCCCS Information Services Division (ISD)
• Maintaining AHCCCS FFS policies, including the AHCCCS FFS provider and IHS/tribal provider billing manuals
• Health care service prior authorization and concurrent review
• Fraud, Waste, and Abuse (FWA) monitoring in collaboration and coordination with the Office of Inspector General (OIG) and Attorney General’s Office, including coordination of onsite response to facilitate member care
• Collaborating with the 22 sovereign Arizona tribes to advise on AIHP policy and procedure including attending and participating in Tribal Consultation (TC)

This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Major duties and responsibilities include but are not limited to:
• Lead DFSM's administrative and clinical functions, in direct coordination with the DFSM Assistant Deputy Director, directing the DFSM leadership team to execute their responsibilities.
• Coordinate DFSM operational and financial functions with other AHCCCS Divisions, including Division of Budget and Finance (DBF), Information Services Division (ISD), Office of Inspector General (OIG), Division of Member and Provider Services (DMPS), and other AHCCCS Divisions as needed.
• Engage and collaborate with external partners, including Indian Health Services, tribal 638s, the tribes, and the urban Indian clinics through formal (i.e., Tribal Consultation, TRBHA IGAs) and informal means.
• In collaboration with the senior leadership and tribal stakeholders, develop and communicate the division's strategic plan, effectively lead DFSM programs and initiatives in conformance with the agency's vision and mission and ensure continuous quality improvement/lean concepts are fully implemented in the division.
• Acts as the final review and approval authority of DFSM administrative services including budget, personnel, and procurement, while maintaining compliance with state and agency policies and procedures.

Knowledge:
• Federal and state regulations related to Medicaid and Medicare
• AHCCCS rules, regulations, policies, and procedures
• Managed care concepts and practices
• Health care principles including Integrated healthcare principles, Arizona’s behavioral health delivery system, Tribal/Regional Behavioral Health Authorities
• Techniques to predict and manage personnel demands of large and complex operations
• ICD-10 diagnosis coding, CPT/HCPCS procedure coding
• Responsibilities of state regulatory agencies and channels of decision-making authority
• Financial management, state budgeting process, personnel management, operations
• Continuous quality improvement/Lean Concepts
• Claims and coding submission practices
• Principles and practices of program/project management, and effective supervision/motivation of a leadership team
• Utilization Review and Prior Authorization methods, practices, and processes
• Validation and statistical analysis of data

Skills:
• Strong interpersonal relation skills
• The analysis, evaluation and resolution of complex problems
• Excellent interpersonal skills in one-on-one and up to large groups
• Effectively collaborating with people in position on all levels
• Effectively leading and/or facilitating a team of professionals from within and/or outside the agency
• Developing public presentations and public speaking
• Conflict resolution
• Project management to meet goals and deadlines
• Microsoft Office or comparable software program to include Word, Excel, PowerPoint, SharePoint & Outlook or Google equivalent
• Strong oral and written communications skills.
• Organizational skills to coordinate and keep on target a large number of programs and projects simultaneously
• Time management
• Proficient in budget and personnel analysis, and system design management

Abilities:
• Work closely and in a positive manner with the Governor’s Office, legislators, other state agencies, tribal leaders, stakeholders, MCOs, providers, etc.
• Listen, assimilate and present complex information in a clear and concise manner.
• Multi-task in a fast paced environment where re-prioritization occurs frequently
• Produce work products with limited supervision
• Understand and communicate data/health analytics
• Effectively lead, motivate, and develop employees
• Develop and improve programs and ensure compliant, quality-driven health services
• Effectively prioritize and/or delegate work
• Informed decision-making and personal/team accountability
• Coordinate a large number of programs & projects simultaneously and keep on target
• Determine goals & objectives for the Operational Administration Section that aligns with the Agency's Strategic Plan
• Make decisions based on sound judgment
• Effectively interact with AHCCCS contractors, IHS, the tribes and urban clinics to develop a spirit of cooperation

Arizona Driver License

Minimum: Any combination of training and experience that meet the knowledge, skills, and abilities (KSA's) required; typical ways KSAs are obtained may include but are not limited to, a relevant degree (business, healthcare administration or a health related field) from an accredited college or university, coursework and/or work experience relevant to the assignment.

Preferred: 5+ years of Medicaid/Medicare experience that includes a clinical background; the design development and administration of a managed health care program; and experience in managing, motivating and leading high-level professionals. Experience or knowledge of the Tribal healthcare delivery system.

• 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.