Cigna Utilization Review Remote Jobs in Arizona (NOW HIRING)

Public Healthcare Consultant
Job No: 541293
Work Type: Full-time
Location: REMOTE OPTIONS, PHOENIX
Categories: Administrative Support/Customer Service, Healthcare/Medical Professional Level, Healthcare/Medical Support Level, Research, Healthcare/Nursing/Investigations/Compliance
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.
Public Healthcare Consultant
Division of Managed Care (DMC)
Job Location:
Address: 150 North 18th Avenue Phoenix, Arizona 85007
All AHCCCS Employees must reside within the state of Arizona.
Posting Details:
Starting salary at $71,032 and may be increased based on experience and qualifications.
Grade: 22
FLSA Status: Exempt
This position will remain open until filled.
Job Summary:
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.
Major duties and responsibilities include but are not limited to:
• Oversight and monitoring of EPSDT, women's preventive health, family planning, and maternity care programs to ensure state and federal requirements are met.
• Participate in operational reviews, administrative reviews, technical assistance, and focused studies/reviews to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, corrective action plans and other compliance actions as appropriate.
• Represent the MCH EPSDT Unit in the development and revision of contracts, amendments and policy. This position may participate in work groups, steering teams, and scoring teams as needed and requested by the agency.
• Provide education and technical assistance to internal and external stakeholders, including Contractor's and FFS providers, as appropriate regarding covered services, and contractual or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve EPSDT and maternal child health services to AHCCCS members. Includes identification, research and resolution of issues as needed.
• Collaborate with other AHCCCS units and state and local health and social service agencies, including ADHS, DES/DDD, DCS, Head Start, Vaccines for Children (VFC), childhood blood lead prevention program etc. as well as community and private health care providers.
• Coordinate and complete tracking, evaluation, and responses to Contractor deliverables such as annual program plans and member materials, to assure MCH EPSDT components are thoroughly addressed and align with policies.
• Lead special projects and reviews to ensure completion within the designated timelines and alignment with current recommendations. Provide ongoing updates to Management.
Knowledge, Skills & Abilities (KSAs):
Knowledge:
• State and Federal rules, regulations, policies and procedures governing Title XIX, Title XXI, Managed Care, and LTC and Tribal lines of business
• Medical/nursing practice, medical case management protocols, quality management and utilization review protocols as related to the all populations including maternal and child health services, women's preventive health, family planning services and supplies, EPSDT, acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, behavioral/mental health, children in the foster care system and Tribal lines of business
• Current quality improvement and health care theories and practices
• Background in and knowledge of quality management principles and accreditation bodies' review processes
Skills:
• Organizational skills for setting priorities, workload, and record keeping
• Project management to meet goals and deadlines
• Public speaking and delivering presentations or technical assistance to internal and external stakeholders
• Written communication and correspondence with internal and external stakeholders
• Problem-solving techniques, evaluation, and initiation of appropriate action
• Research and analytical skills
• Interpret and apply rules, regulations, and policies to MCH EPSDT program operations and oversight activities
• Interpret clinical information
Abilities:
• Develop, implement and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, Sister Agency and/or tribal Contractor's
• Manage multiple priorities effectively
• Lead special projects
• Collaborate with internal and external stakeholders
• Identify gaps and recommend solutions
Qualifications:
Minimum:
• Must maintain a current Arizona medical license (RN or higher) and 3 years of relevant healthcare experience. May require a valid Arizona Driver License for travel-related duties.
Preferred:
• Experience in Prior Authorization, Utilization Management, claims review, auditing, or managed care; knowledge of population served.
Pre-Employment Requirements:
• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency's ability to reasonably accommodate any restrictions.
• Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver's License Requirements.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
Benefits:
Among the many benefits of a career with the State of Arizona, there are:
• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here.
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Retirement:
Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.
Contact Us:
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.
Advertised: 20 Jul 2026 US Mountain Standard Time
Applications close:
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