Imx Medical Management Services Jobs (NOW HIRING)

The Medical Services Manager oversees daily operations of the health and dental programs  within the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP). In this role, you'll guide utilization management activities, support decisions on complex cases, and ensure all processes meet State Contract requirements-from medical necessity reviews to care coordination.

You'll analyze medical management data and quality initiatives to identify trends, support evidence-based practices, and implement improvements. Working across teams, you will help enhance patient outcomes, reduce unnecessary utilization, and improve the overall quality of care for the children and youth served by the plan.

• Manages staff in a select area of the DCS CHP healthcare delivery system (physical and dental health) including Registered Nurses and Clinical Care Coordinators. Responsible for daily review and monitoring of team's work flows and processes to ensure that they meet plan, policy, and compliance standards within the medical management area. Monitors timeliness of utilization activities.
  
• Conducts and collaborates on clinical case reviews, medical consultations, Child and Family Team (CFT) meetings and care conferences as well as participates in on-call rotation and handling incoming inquiries from members, providers, caregivers and DCS staff.
  
• Creates, edits and revises policies annually, as well as, assists team with monthly, quarterly, and annual deliverables as determined by AHCCCS.
  Formulates and updates plans and priorities to address any departmental or operational challenges.
  
• Hires, trains, coaches and audits the Medical Management Team. Acts as a clinical reviewer and mentor on complex cases including pharmacy or service prior authorizations as well as case review on high utilization members or risk management cases as needed.
  
• Implements and evaluates the Medical Management program and work plan in accordance with DCS mission and strategic goals, as well as federal and state laws and regulations. Resolves and communicates utilization management issues and concerns, corrective action plan activities and reporting.
  
• Participates in joint operating meetings with DCS CHP's contracted health plan and assists with clinical projects and plans. Collaborates to assure integration, quality and efficiency of utilization management.
  
• Reviews and analyzes health data, including inpatient, outpatient, and pharmacy data to identify trends, potential areas requiring system updates/changes and training opportunities (internal and external). Reviews, analyzes, and reports utilization metrics.
  
• Facilitating or leads various committees' structures. Presents at the Quality Management and Medical Management Committees. Leads review of regulatory standards impacting Utilization Management/Prior Authorization. Represents Medical Management in external meetings and activities.
  
• Other duties as assigned as related to the position.

Knowledge of:

• Utilization Management practices and programs (including Prior Authorization)
  
• Leadership and organizational principles, oversight and regulatory methodologies, and managed care delivery systems.
  
• State legislative laws, regulations and rules related to behavioral health care and child welfare
  
• Pediatric care programs and clinical standards
  
• Evidence-based criteria
  
• Principles of managed care, Arizona Health Care Cost Containment System (AHCCCS) and Medicaid

Skills in:

• Direct management and coaching
  
• Prioritizing numerous responsibilities and effectively managing time to meet deadlines
  
• Utilizing computer software and applications such as Microsoft Office Word, Excel, and PowerPoint
  
• Applying the principles of management
  
• Analysis and decision-making
  
• Clinical problem-solving/trouble-shooting
  
• Verbal and written presentation and communication

Ability to:

• Meet deadlines
  
• Lead a team including cross functional departments
  
• Plan, analyze, and coordinate activities
  
• Implement strategic plan for Medical Management
  
• Navigate Information Systems
  
• Remain up-to-date on clinical criteria and AHCCCS policies/procedures
  
• Represent DCS within the community and state regarding health issues for children/youth in foster care

N/A

Independently licensed physical and/or behavioral health clinician with ability to practice under an unrestricted AZ license: Registered Nurse (RN),
Nurse Practitioner (NP), Physician (MD/DO).
A minimum of five (5) years' nursing experience or the equivalent.
The ability to secure and maintain clearance from the DCS Central Registry.

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).

The State of Arizona provides an excellent comprehensive benefits package including:

• Affordable medical, dental, life, and short-term disability insurance plans
  
• Top-ranked retirement and long-term disability plans
  
• 10 paid holidays per year
  
• Vacation time accrued at 4:00 hours bi-weekly for the first 3 years
  
• Sick time accrued at 3:42 hours bi-weekly
  
• Deferred compensation plan
  
• Wellness plans

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

Positions in this classification participate in the Arizona State Retirement System (ASRS). Enrollment eligibility will become effective after 27 weeks of employment.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-255-3141 or by email at ADA@AZDCS.GOV. Requests should be made as early as possible to allow time to arrange the accommodation. Should you have any further questions regarding the interview process you can reach out to a member of our recruitment team at 602-255-2903 or by email at recruiting@azdcs.gov. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.