State of Arizona :

 

Job Information
Job Title:  UTILIZATION MANAGEMENT CLINICAL MANAGER 
Agency:  DEPARTMENT OF CHILD SAFETY 
Job Reference ID:  54967 
Category:  MEDICAL/HEALTH SERVICES 
Grade:  24 
Posted Date:  05/23/2020 
Close Date:   
Job Description



Arizona Department of Child Safety

A New Beginning for Arizona’s Children

UTILIZATION MANAGEMENT CLINICAL MANAGER

(RN or RNP License Required)
Comprehensive Medical and Dental Program
3003 N. Central Avenue

Phoenix, AZ 85012

www.azdcs.gov

DCS Mission Statement

Successfully engage children and families to ensure safety, strengthen families, and achieve permanency.

JOB SUMMARY:

The Department of Child Safety is in search of a Registered Nurse to serve in the role of the Utilization Management Clinical Manager.  This position provides daily oversight of the medical management programs for the Comprehensive Medical and Dental Program (CMDP).  This position also plans and evaluates utilization review functions and assists the Chief Medical Officers and Associate Medical Directors in decision making.  In addition, this position will coordinate Early and Periodic Screening Diagnostic (EPSDT) activities.  

 

This position reviews, analysis, and reports utilization metrics, and implements medical management plan activities.  This position also works cross functionally to improve patient outcomes and satisfaction, control the cost of care, reduce unnecessary readmissions and utilization, and improve the overall quality and health outcomes of the children/youth enrolled in the plan.   

 

This position manages the supervisory and direct clinical and non-clinical staff in Medical Management Health Services.

 

The Comprehensive Medical and Dental Program (CMDP) is the health plan responsible for ensuring partnership with foster care providers, and the provision of appropriate and quality health care services for the well-being of Arizona's children in foster care.

 

JOB DUTIES: 

-          Manages staff in a select area of the CMDP healthcare delivery system (behavioral health and physical/dental health) including utilization staff that perform Concurrent Review/Prior Authorization 

-          Reviews and monitors medical management work flows and processes

-          Hires, trains, and coaches and audits the Medical Management team, acts as a clinical reviewer, and provides mentoring on complex cases

-          Conducts on-site case reviews on high utilization members, or risk management cases as needed

-          Implements and evaluates the Medical Management program and work plan in accordance with the DCS mission and strategic goals

-          Implements federal and state laws and regulations

-          Resolves and communicates utilization management issues/concerns, and corrective action plans

-          Participates in joint operating meetings with vendors such as Pharmacy Benefits Manager (PBM) and delegated entities

-          Facilitates and leads various committee structures

-          Presents at Quality Management and Medical Management Committees; in addition to representing Medical Management in external meetings and activities

-          Reviews and analyzes inpatient, outpatient, and pharmacy health data to identify trends

-          Reviews retrospective claims data for potential utilization concerns

-          Conducts and collaborates on clinical case reviews, and investigates appropriateness of health claims reimbursements

-          Participates in on-call rotation, maintaining incoming inquiries from pharmacies, members, providers, caregivers, and DCS staff

-          Performs other duties appropriate to the assignment

 

 

 

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

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, clinical standards  (evidence based criteria)

-          Principles of managed care (AHCCCS / Medicaid)

Skill in:

-          Direct Management and coaching

-          Prioritizing numerous responsibilities

-          Time management

-          Computer software (Word/Excel)

-          Management and analytical decision making

-          Clinical problem solving and trouble shooting

-          Verbal and written communication

-          Establishing and maintaining interpersonal relationships

 

Ability to:

-          Meet deadlines

-          Lead a team, including cross functional departments

-          Plan, analyze, and coordinate activities

-          Implement strategic plans for Medical Management

-          Effectively communicates to internal and external groups

-          Provide trainings to other health professionals and paraprofessionals

-          Manage detailed, complex concepts/problems, and make rapid decisions

-          Navigate information systems

-          Provide up to date knowledge on clinical criteria, and AHCCCS policies/procedures

-          Represent DCS within the community and state regarding health issues for children/youth in foster care 

 

 

SPECIAL SELECTION FACTOR(S): 

Required: Licensed Registered Nurse (RN).

Must be able to secure and maintain clearance from the CPS Central Registry.

PREFERRED QUALIFICATION(S):

-          A minimum of five (5) years’ experience, with a minimum of two (2) years’ experience in managed care within utilization or case management

-          Two (2) plus years management experience

-          Managed Care Health Plan experience

PRE-EMPLOYMENT REQUIREMENTS: 

Employment is contingent on the selected applicant passing a background investigation.

BENEFITS: 

We offer a comprehensive benefits package that includes: 

-          Sick leave

-          Vacation with 10 paid holidays per year

-          Health and dental insurance

-          Retirement plan

-          Life insurance and long-term disability insurance

-          Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

RETIREMENT: 

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 602-255-2903. Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

 

 
Position Requirements
Position Level:    Hours:   
 Work Arrangement:     Employment Type:   
Hourly Rate:  $0.00 / per hour  Salary:  $82,000.00-82,000.00 

 

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