Program Development Specialist Senior

Job Summary :

This position is responsible for managing, researching, and coordinating concerns related to network access to care of service providers.

Having an understanding of federal and state regulations related to network requirements, Medicaid provider and managed care plan relations, as well as AHCCCS contract and policy requirements.

Major duties and responsibilities include, but are not limited to :

• Monitor complaints against health plans related to network access to care issues, ensuring adequate network of service providers to meed the needs of the population, including tracking and managing complaints related to access to care.
• Receive, review, research, and respond to access to care complaints received from internal an external stakeholders.
• Oversee health plan deliverables, review for compliance and identify any potential access to care concerns.
• Conduct assessment of network sufficiency by performing network surveys, outreach calls, and secret shopper calls to confirm member access to care.
• Serve as a representative of the DHCS Network team in committees related to access to care.

Knowledge, Skills & Abilities (KSAs) :

Knowledge :

• Provider Network Planning, development, and monitoring
• Behavioral health, long term care, and physical health service delivery system and operations
• Medicaid provider and managed care operations
• Licensure regulations
• State Medicaid agency regulations
• Managed care concepts
• Medicaid provider and managed care options
• Interpersonal communication / conflict resolution process
• Project management

Skills :

• Strong interpersonal skills to effectively relate to members and / or their families, multidisciplinary professionals, contractor representatives, and stakeholders
• Analytical skills
• Problem solving and trouble shooting skills
• Group facilitation and organizational skills
• Information collection and synthesis skills
• Data analysis, interpretations, and reporting

Abilities :

• Assess network sufficiency through a holistic perspective with emphasis on medical, social, environmental conditions and barriers for meeting unique needs
• Communicate effectively both orally and in writing within all levels of the organization
• Exercise initiative, judgment, and problem solving
• Establish and maintain cooperative working relationships with leadership
• Research and prepare comprehensive reports
• Organize work to achieve goals and objectives

Selective Preference(s) :

Minimum :

Two years of experience in healthcare and / or project management.

Preferred :

Bachelor's degree in Business or Healthcare Management and 3 years experience in healthcare and / or project management.

Experience in working in a managed care provider or managed care provider relations environment.

Pre-Employment Requirements :

• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• 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 (see Arizona Administrative Code .

AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license.

If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business.

Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration;

however, mileage will be reimbursed.

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 :

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits :

Among the many benefits of a career with the State of Arizona, there are :

• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster / adopted child (pilot program).
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities

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 . For a complete list of benefits provided by The State of Arizona, please visit our

Retirement :

Lifetime Pension Benefit Program

• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.
30+ days ago