Medical Management Supervisor

State of Arizona - Phoenix, AZ

Job Title: Medical Management Supervisor

Position: Supervises and evaluates Medical Management programs for AHCCCS

Job Type: Full Time

Pay: $72,000 - $78,650

Shift:

Work Type: On-Site

Location

Address:

City: Phoenix

State: AZ

ZIP Code:

Job Responsibilities

Supervise, train and assist in the distribution of work assignments.
Conduct work review and performance appraisal.
Hire personnel as needed.
Write, implement, and review the performance of AHCCCS Acute Care and Arizona Long Term Care System Health Plans.
Assist in the Operational and Financial Review process and corrective action plans.
Provide technical assistance to Contractors as needed.
Review and analyze data provided by Contractors/Health Plans.
Track compliance with the reporting of Contractors/Health Plans per contract guidelines or AHCCCS requests.
Develop, update, review and interpret AHCCCS policies, rules, and regulations.
Research changes and additions in policies and communicate the impact to division/agency management.
Coordinate Transplant Activities for Tribal Fee for Service members.
Provide technical assistance to Program Contractors/Health Plans regarding transplant policy.
Interface and review compliance of contracted facilities according to AHCCCS facility contract.
Identify and report deficiencies with facility contracts.
Review Reinsurance medical records and document findings.
Analyze trends and communicate trends to the Medical Management Manager.
Communicate with internal and external staff and respond to requests within designated timeframes.
Maintain active Catastrophic member list and manage communications regarding Reinsurance approval.
Review Reinsurance requests and apply medical criteria for approvals.
Report any untoward trends to the Medical Management Manager.
Perform other duties as assigned.

Required Skills

Core Skills

Principles and practices of Utilization Management
Knowledge of Federal Regulations, State Statutes, and AHCCCS policy
Management information systems basic knowledge
Computer proficiency in Outlook, Word, and Excel
Current medical knowledge including evidence-based medicine standards

Preferred Skills

Analytical and comprehension skills for utilization management data
Strong oral and written communication skills
Organizational skills

Requirements

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

Education: Current license to practice as a registered nurse in Arizona; Master's degree preferred.

License & Certification:

Registered Nurse License 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 of up to 12 weeks for newborn or newly-placed foster/adopted child
Other Leaves: Bereavement, civic duty, and military
Lifetime pension benefits
Affordable insurance plan including medical, dental, life, and disability insurance
Participation eligibility in the Public Service Loan Forgiveness Program
RideShare and Public Transit Subsidy
Career development opportunities
Full-time or part-time remote work schedule options