Internship Prior Authorization Jobs (NOW HIRING)

Under the direction of the Clinical Administrator, responsible for the management and oversight of the DFSM Medical Prior Authorization/Utilization Review (PA/UR) and Non-Emergency Medical Transportation (NEMT), including direct supervision of unit staff. Responsibilities include operational oversight, provider relations, technology management, reporting, policy implementation, and continuous process improvement to ensure effective service delivery and compliance with program requirements.
Major duties and responsibilities include, but are not limited to:
Provides direct management and oversight of the DFSM PA/UR Unit, Non-Emergency Medical Transportation (NEMT), and Medical Emergency Transportation programs. Supervises assigned staff and is responsible for hiring, training, performance management, employee development, scheduling, workload distribution, and ensuring operational coverage.
Oversees and directs interactions with Fee-for-Service providers, including resolution of escalated provider concerns and operational issues. Independently assesses issues, determines appropriate resolution strategies, delegates follow-up activities, and tracks trends to support process improvement and provider engagement.
Develops, establishes, and maintains reporting structures, performance metrics, and operational processes for the Prior Authorization, Utilization Review, and Transportation programs. Analyzes program data, monitors outcomes, and provides operational leadership and backup support to ensure continuity of services.
Reviews, develops, implements, and maintains prior authorization criteria, policies, procedures, and standard work to support program compliance, consistency, and effective determination of prior authorization requirements. Participates in policy committees, workgroups, and related initiatives.
Serves as the Prior Authorization subject matter expert (SME) and oversees the technological aspects of the Prior Authorization process, including ServiceNow, EDMS, PMMIS, Prior Authorization systems, and related applications. Identifies operational needs, advocates for system enhancements, and collaborates with partners to improve efficiency and effectiveness.
As needed, provides backup for the responsibilities held by the Prior Authorization and Utilization Review staff.

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.

Knowledge of:
Principles and practice management and supervision
Principles and practice of data research and report development
Information technology processes and potential prior authorization processes
Healthcare delivery systems and mechanisms for coordination and delivery of services
Principles of medical and/or behavioral nursing management and assessment
Current standards of medical/behavioral practice and modes of delivery for acute and non-acute medical/behavioral healthcare and services
Current costs, appropriateness and utilization of medical supplies and equipment
Principles of utilization review
Alternative levels of care
ICD-9/10, CPT and DSM IV/V coding and medical billing guidelines
Interrelations of government entities
Federal and state rules, regulations, statues and codes applicable to AHCCCS programs and populations
AHCCCS programs, policies and procedures
Familiarity with American Indian tribes and programs and policies relative to Intergovernmental Agreements (IGA)
Prepaid Medical Management Information System (PMMIS)
Skill in:
Development of provider relations procedures within prior authorization/utilization review
Interface with AHCCCS Information Services Division (ISD) to meet technological needs of Utilization Management/Care Management (UM-CM) unit
Develop effective reporting structures and processes for UM/CM unit
Problem solving and identification, evaluation and initiation of appropriate action, nursing assessment
Proficiency in oral and written communications
Public relations skills, interacting with statewide providers of healthcare services, public organizations, social service agencies and American Indian tribes
Organizational skills for setting priorities, workload and record keeping
Intermediate to advanced computer skills
Interpret clinical information and assess implication for treatment
Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds
Ability to:
Plan, organize and administer a healthcare program
Teach, train and motivate direct report and others
Independent decision making
Represent unit, division and AHCCCS in a positive, constructive manner
Analytical ability to identify and correlate specific patterns, initiate investigations and submit findings and recommendations
Read, interpret and apply complex rules, regulations, statutes, policies and guidelines
Effectively resolve provider issues with minimal disruption
Communicate complex information in an understandable manner

Minimum: Possession of a current license to practice as a registered nurse in the State of Arizona OR Licensed Behavioral Health Professional AND four (4) years professional experience related to health programs appropriate to the assignment, which includes program planning or administration; AND Two (2) plus years of managerial experience or (2) plus years as an AHCCCS Health Care Nursing Consultant. A Master's degree in a field appropriate to the assignment and minimum six (6) years of experience may substitute for the license requirement.
Preferred: Bachelor or Master of Science in Nursing and/or Independent Behavioral Health License, and/or five (5) years of supervisory experience leading a health care team or organization, and national certification relevant to the area of practice.

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.)

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).

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

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.

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.