Clinical Care Specialist

This position is responsible for providing care management and and clinical care coordination for Comprehensive Medical and Dental Program (CMDP) members. The Care Coordinator works with medical professionals, caregivers’ clinic/hospital/specialty providers, and community resources in a team approach to promote timely access to appropriate health care services for CMDP members.

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.

Job Duties:

• Provides care management for members entering into or transitioning from Medicaid healthcare plans; prepares and process Enrollment Transition Information (ETI) documentation; writes and dictates medical case notes, histories, and narratives for use by CMDP clinical staff and DCS Specialists.
  
• Processes prior authorization requests and completes Notice of Actions (NOAs) for medical, dental and orthodontia denials.
  
• Verifies and manages all incoming emergency room utilization and hospital readmissions; research and record non routine or unusual emergency visits; prepares and presents data on inpatient cases and multiple ER visits.
  
• Provides outreach to member caregivers, adoptive or foster parents, DCS Specialists and other agency representatives to initiate member referrals for ALTCS services; provides care management and performs outreach for CMDP members who are identified as pregnant.
  
• Manages and prepares requests for medical records; processes immunization record reports; presents cases to clinical staff for review and decision.
  
• Answers incoming calls; provides customer service regarding general medical and dental inquires; interprets and implements CMDP policies and procedures.
  
• Serves on CMDP committees as assigned; provides assistance and trains other CMDP employees.
  
• Other duties as assigned as related to the position.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:

• Department of Child Safety (DCS) policies, procedures
  
• Current state, federal and local laws governing Arizona Health Care Cost Containment System (AHCCCS) and Medicaid health plan operations
  
• Healthcare administration as it relates to children in foster care
  
• Customer service principles and practices
  
• Microsoft applications
  
• Pediatric medical terminology

Skills in:

• Written and verbal communication
  
• Establishing and maintaining interpersonal relationships
  
• Comprehending and interpreting principles and practices of health plan operations
  
• Problem solving
  
• Navigating within computer applications
  
• Time management and multi- tasking

Ability to:

• Maintain up to date knowledge of agency and department policies and procedures
  
• Understand importance of and respect for the confidentiality of member information in accordance with applicable standards and regulations
  
• Work under pressure in a high paced environment

Selective Preference(s):

Formal training and/or certification in medical and/or dental coding and terminology.

Pre-Employment Requirements:

N/A

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:

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

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 pilot program here.