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Quality Assurance Investigative Nurse in various locations
Under the leadership of the Inspector General and Deputy Assistant Director, this position is responsible for investigation and medical necessity clinical determinations for AHCCCS OIG. These duties include, but are not limited to; investigating, reviewing, evaluating, determining appropriate payment of medical and/or behavioral healthcare services, and medical record reviews with clinical expertise in procedures and processes in the clinical setting. Assurance of compliance with contractual, regulatory, and statutory obligations for AHCCCS members (in both Managed Care Organization (MCO) and Fee for Service (FFS) settings) for physical/acute care services, LTC supports and services, and behavioral health needs and providing subject matter expertise (SME) in a variety of settings. This position is accountable for the prevention and/or resolution of alleged billing concerns, utilization, and determination of any fraudulent activities, waste or abuse of the Medicaid program, identification of criminal activity, and review of system parameters in accordance with AHCCCS rules, regulations and federal guidance. Direct clinical investigative knowledge and expertise is applied by this position in review and timely resolution of the cases assigned, identification of Fraud, Waste and Abuse (FWA) in clinical reviews and collaboration with AHCCCS Divisions, Managed Care Organizations, Law Enforcement Agencies, and other regulatory agencies as identified within the scope of each unique case.
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Business Analysis Supervisor - Data Governance in PHOENIX
A career in public service awaits you. COME JOIN OUR TEAM! A great benefit of working for the State of Arizona is a fantastic work/life balance. State employees enjoy challenging work, popular remote work options, comprehensive health and wellness benefits, and career growth opportunities. The State of Arizona ranks #30 in Healthiest 100 Workplaces in America! This recognition honors organizations that champion employee wellbeing through innovative health programs, inclusive wellness initiatives, and a culture rooted in care.
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COMPLIANCE SAFETY HEALTH TECHNICIAN in PHOENIX
We are currently looking for an individual to joint our Arizona Division of Occupational Safety & Health (ADOSH) team, which is tasked with conducting compliance assistance visits throughout Arizona. Our visits help employers understand what OSHA and consensus standards that apply in the workplace. Industrial Hygiene Technicians will work under close supervision in learning determine and enforce occupational health and safety and public and private establishments in construction, general industry, agriculture, and public entities.
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INVESTIGATOR 2 in various locations
The Arizona Board of Behavioral Health Examiners is seeking a motivated individual to join our team in the role of Investigative Assistant. The Investigative Assistant will be responsible for conducting a wide range of administrative and clerical tasks in support of the Board's investigative team. This position will also be responsible for conducting small-scale investigations and inquiries. This position 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.
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Business Analyst -Healthcare Report Developer in PHOENIX
A career in public service awaits you. COME JOIN OUR TEAM! A great benefit of working for the State of Arizona is a fantastic work/life balance. State employees enjoy challenging work, popular remote work options, comprehensive health and wellness benefits, and career growth opportunities. The State of Arizona ranks #30 in Healthiest 100 Workplaces in America! This recognition honors organizations that champion employee wellbeing through innovative health programs, inclusive wellness initiatives, and a culture rooted in care.
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