Medical Management Manager

Medical Management Manager Division of Managed Care (DMC) Job Location

150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona.

Salary: $90,000 - $96,000. Grade: 24. FLSA Status:
Exempt. This position will remain open until filled.

Under the leadership of the Deputy Assistant Director for Clinical Program Management within the Division of Managed Care, this position oversees the Medical Management unit and its core functions, including prior authorization, concurrent review, care and disease management, quality of care concerns, and health plan oversight. The role requires high-level management and strategic decision-making, ensuring compliance and operational excellence while collaborating across clinical and non‑clinical units.

This position also provides direct leadership to staff, implementing AMS/lean principles, fostering professional development, and maintaining confidentiality. Additionally, the manager develops and enforces oversight processes for AHCCCS contracted health plans, handling proprietary and highly protected health information with discretion.

• Act as an Agency subject matter expert for clinical concerns, provide technical assistance, review Director's Decisions regarding member care, intervene for "care needed today" cases, monitor and evaluate all aspects of medical management, including care coordination, high needs/high cost, behavioral health, and Mental Health Parity.
• Support policy efforts related to medical management, including drafting newly identified policies as well as revising current policy. Ensure clarity and evaluate MCOs on implementation and compliance.
• Participate in Agency initiatives as appropriate, including but not limited to Requests for Proposals, Mental Health Parity, Targeted Investment, Justice Reach‑In, and others as identified.
• Interface with transplant facilities, address claims concerns related to transport, support the AHCCCS finance team with questions regarding reinsurance and other payments, and support overall efforts related to transplant efforts for all AHCCCS population.
• Manage a team of professional staff to support ongoing learning and development, provide guidance and resources as needed, support problem solving, conduct regular team and individual meetings, and recruit for new staff as needed.
• Provide direction and oversight of the Contractor's Notice of Action process. Conduct regular audits and provide technical assistance as needed.
• Assign topics for the Technology and Services Committee and provide oversight to the Committee. Participate in the Clinical Oversight Committee and provide data and documentation as requested.

• Principles and practices of medical management/utilization management
• Federal Regulations, State statutes, rules, policy and procedure governing the AHCCCS program
• AHCCCS contractual arrangements with contractors
• Management information system
• Working knowledge of computer system capabilities
• Health care administration principles and practices
• Research design, analysis (including statistics) and interpretation techniques
• Internal mechanisms of hospitals
• Health care industry coding standards including the use of diagnosis, procedure and HCPCS coding
• Medical terminology

• Strong clinical skills
• Analytical and comprehension skills to interpret utilization management data within the context of federal and state statutes, rules and regulations
• Excellent oral and written communication skills
• Effective interpersonal skills
• Effective management and leadership skills, including organizational and project management skills
• Meeting facilitation
• Problem‑solving
• Delegation, including involvement of team in key processes as appropriate

• Multi‑task in a fast paced environment, reprioritizing as needed
• Problem solve and support problem solving of staff
• Make decisions that impact the team and Agency, at times on short notice and with limited information available

• Active license as a Registered Nurse, Nurse Practitioner, or Physician Assistant is required for this position.
• Four plus years professional experience related to utilization management, which includes program planning or administration.

• Master's degree in the healthcare field may substitute for one year of the required experience. Two plus years experience working in Medicaid, managed care or health plan administration.

• 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.
• All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility…