Medical PA/UR & Transport Manager

at State of Arizona in PHOENIX, Arizona, United States

Job Description

Job No: 543194

Work Type: Full-time

Location: REMOTE OPTIONS,PHOENIX

Categories: Healthcare/Medical Support Level,Management/Supervisor,Healthcare/Nursing/Investigations/Compliance

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.

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.

· 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

Preferred: Bachelor or Master of Science in Nursing and/or Independent Behavioral Health License, and/or five (5) years of supervisory exper