Clinical Review Unit Manager

State of Arizona - Phoenix, AZ

Job Title: Clinical Review Unit Manager

Position: Division of Fee for Service Management (DFSM)

Job Type: Full Time

Pay: $83,600

Shift:

Work Type: On-Site/Remote

Location

Address:

City: Phoenix

State: AZ

ZIP Code:

Job Responsibilities

Provides direct management of the Clinical Review Unit and manages the nursing staff and non-nursing staff.
Participates in Division and Agency Policy Committees.
Oversees and directs the technological aspects of the CRU processes and maintains reporting structures and processes.
Provides oversight and directs team interaction with Fee-for-Service (FFS) Providers and stakeholders.
Ensures provider issue resolution including grievance and appeals, and provides technical assistance.
Works in conjunction with other clinical teams in the DFSM, and staff and teams in other AHCCCS divisions, and external partners as required on quality related matters.
Provides oversight of the team’s participation in special processes, such as SMI or SED determination and OHR assistance.
Acts as a FFS subject matter expert while assisting in the development of policies and procedures for the delivery of covered health care services.

Required Skills

Core Skills

Medical terminology CPT and ICD procedural coding
Industry standards for retrospective utilization review
Medical billing guidelines
Knowledge of clinical protocols and expected outcomes
Strong oral and written communication
Management and human relations skills

Preferred Skills

Certification as a professional CPT coder
Experience in medical coding/billing
Experience working in the tribal healthcare delivery system

Requirements

Experience: Four (4) years professional experience related to health programs including program planning or administration, and two (2) plus years of managerial experience.

Education: Possession of a current license to practice as a registered nurse in the State of Arizona; a Master's degree may substitute for one year of required experience.

License & Certification:

Current license to practice as a registered nurse in Arizona

Schedule:

COVID-19 Requirements: Not Specified

Benefits

10 paid holidays per year
Paid Vacation and Sick time off (13 and 12 days per year respectively)
Paid Parental Leave-Up to 12 weeks per year for newborn or newly-placed foster/adopted child
Other Leaves - Bereavement, civic duty, and military
Top-ranked retirement program with lifetime pension benefits
Robust insurance plan, including medical, dental, life, and disability insurance
Eligibility in the Public Service Loan Forgiveness Program
RideShare and Public Transit Subsidy
Learning and career development opportunities
Option for full-time or part-time remote work schedule