Job Description

Our Mission:  Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.

Our Vision: 

Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.

Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!

Position Purpose:

The Medical Management Specialist is responsible for completing prior authorization and concurrent reviews for substance abuse residential facilities. The position serves as a subject matter expert for Health Choice concerning members with substance abuse or co-occurring disorders.

Responsibilities:

  • Conducts prior authorization and concurrent reviews for substance abuse residential treatment facilities and other designated services.    
  • Assessment of post discharge needs and coordinates of services.
  • Refers members to care management and disease management programs.
  • Completes Notices of Action or Notices of Decision and maintains accurate clinical documentation of authorizations, case management, concurrent review and discharge.
  • Serves as subject matter expert for substance abuse services, and as a resource for program specialties, including cultural appropriateness. Provides support and technical assistance to providers.
  • Consults with Medical Director as need to review complex cases.

Education / Experience / Other Requirements

Education:   

  • This position requires a Master’s degree in a behavioral health field, Registered Nurse or an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position
  • This position also requires an independent behavioral health license for the state of Arizona.

Years of Experience:  

  • 2 Years of experience in behavioral health field.
  • 2 years of experience with the treatment of members with substance abuse and co-occurring disorders.    
  • Preferred experience with prior authorization and concurrent review process.  

Specialized Knowledge:  

  • Knowledge of Arizona Medicaid system and behavioral and AHCCCS health systems
  • Psychiatric and substance abuse diagnoses, psychiatric medications and standards of care
  • Medical necessity criteria
  • Managed care principles; ability to prioritize and effectively handle multiple projects
  • Communicate effectively both verbally and in writing; use of a variety of computer-based technologies including Microsoft Office applications
  • Ability to work effectively and efficiently as a team member or independently.

Skills & Abilities:

  • Strong interpersonal skills. 
  • Critical thinking, ability to make independent decisions and refer to others as necessary. 
  • Understanding of medical records and UR systems. 
  • Ability to type 35 word per minute.
  • Excellent computer skills navigating various systems/platforms and skills using Microsoft Office Suite
  • Excellent writing and documentation skills and customer service.    

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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