Health Program Manager

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Division of Managed Care (DMC)

150 North 18th Avenue Phoenix, Arizona 85007

The purpose of this position is to implement the Pre-admission Screening and Resident Review (PASRR) program for Arizona residents admitted to a skilled nursing facility. This position is responsible for coordinating and evaluating Level I and Level II PASRR submissions to ensure compliance with Federal and State rules and regulations related to PASRR. This position audits submissions for accuracy and completeness and utilizes clinical judgment to evaluate decisions made by submitting providers and ensures that Level II requests are processed in accordance with policies and reviewed timely by the third-party clinicians.

This position may offer the ability to work remote, 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:

• Coordinate and monitor the processing of PASRR referrals and evaluations. Use clinical judgement to evaluate the accuracy and completeness of Level I and Level II submissions as well as to determine which third-party reviewer is best suited to address Level II submissions (behavioral health professional or intellectual/developmental disability professional).
• Maintain the PASRR mailbox/Portal and update the PASRR database to monitor and track clients. Provide support to providers by addressing inquiries and/or connecting providers with ISD or other appropriate resources. Resolve discrepancies and provide general problem solving efforts regarding the PASRR program (e.g. concerns, appeals, grievances
• Assist with development and monitoring of the program policies and procedures, including performance audits to ensure conformance with federal and state laws, and all legal mandates.
• Support training initiatives and provide technical assistance to internal staff, MCOs and providers as…