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Clinical Quality Management Coordinator in various locations
This position will work independently applying clinical knowledge, judgment, and expertise to assess, coordinate, and monitor service delivery. This position will complete comprehensive assessments of available resources on service providers and individual members; review case material to ensure compliance with State and Federal regulations and policies; and provide timely resolution of multiple cases assigned. This position will also be responsible for identifying systemic issues for AHCCCS to address. This position will be hybrid with some in-office meetings, on-site investigations, and reviews as needed. Occasionally, this position may also participate as needed in urgent on-site investigations and reviews outside of normal business hours and weekends.
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Public Health Nursing Consultant in various locations
The Division of Managed Care (DMC) is looking for a highly motivated individual to join our team as a Maternal Child Health (MCH) Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Coordinator. Under the leadership of the MCH EPSDT Program Manager, this position provides oversight of the EPSDT, women’s preventive health, family planning, and maternity care services within AHCCCS’s statewide managed care and fee for-service programs. This role ensures services that support pregnant and postpartum members; infants and children are delivered in compliance with state and federal requirements. This position is responsible for quality improvement activities, validating deliverables, identifying gaps and recommending strategies to improve performance.
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Auditor 3 in various locations
This position is directly involved in negotiating the final determination of financial over-payments and recommending civil monetary penalties levied against providers participating in fraudulent billing practices. The information obtained by this position is used for a variety of activities such as: determination of fines, restitution and cost avoidance; internal deliberation's regarding settlement amounts for fines and restitution, participate in the decisions regarding opening and closing of criminal and civil investigations.
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Network Administrator in various locations
Responsible for the Network unit, ensuring managed care health plan network sufficiency and access to care for members. Participate as a lead role in the development of network standards and guidelines.
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BENEFITS AND ELIGIBILITY SPECIALIST (ELIGIBILITY INTERVIEWER) in PAYSON
Exciting and Rewarding Opportunity!
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