Medical Eligibility Specialist
The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.
Medical Eligibility Specialist
*This position will be stationed in the Chinle office*
The Division of Member and Provider Services (DMPS) is looking for a highly motivated individual to join our team as a Medical Eligibility Specialist (PAS Assessor) for the Arizona Long Term Care System (ALTCS) in the Chinle Office. This position will assess customers of all potential populations, elderly and physically disabled (EPD), and developmentally disabled (DD) in both institutional and community-based settings to determine medical eligibility for long term care.
* Assessing customers in a face-to-face interview using the Pre-Admission Screening (PAS) instrument to determine medical and occasionally financial eligibility for ALTCS.
* Reviewing medical records and interacting with customer’s family members, caregivers and/or physicians to identify and evaluate medical and psycho-social conditions.
* Driving to customer’s place of residence or various settings to conduct interviews and/or obtain pertinent medical documentation.
* Conducting interviews with persons who are physically disabled, developmentally disabled or those who are elderly.
* Referring customers to appropriate community resources, based on their needs.
* Managing a heavy caseload with clearly identified and regularly monitored productivity and quality requirements.
* Using a desktop computer/laptop and other computer programs for interviewing, updating, reviewing and completing medical eligibility determinations.
* Phase 1 of the Candidate selection process requires completion of a writing exercise within a required timeframe. Candidates are contacted by email.
* Due to COVID-19 precautions the recruiting process has been adjusted to meet the standard health guidelines outlined by the State. Interviews will be conducted virtually and may also be by way of video conference utilizing a platform like Google Meet/Hangouts or WebEx.
Knowledge, Skills & Abilities (KSAs):
* Demonstrated knowledge of medical, functional and psycho-social problems of the elderly, physically disabled and developmentally disabled children and adults.
* Demonstrated knowledge of medical terminology and procedures.
* Demonstrated knowledge of available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.
* Fundamental principles of medical nursing services, alternatives to long term care, length of stay, pharmacology and equipment use.
* Experience with caseload management; schedules and timetables; effectively prioritizing; analyzing, assessing and evaluating service provisions and quality of care.
* Strong ability to establish and maintain effective working relationships with professional staff, caregivers, customers’ families, children and adults and with representatives of courts and various other agencies in the community.
* Strong ability to communicate effectively, both orally and in writing; reading, understanding and applying rules, regulations and policies.
* Ability to elicit information and gain insight into customers and families; using a personal computer/laptop and computer programs to document information.
* Ability to solve mathematic problems accurately.
* Ability to be fluent in Navajo.
* Meet at least one of the following qualifications: Possess an active Arizona RN license; OR a Bachelor’s or Master’s degree in Social Work or closely related field and 2 years of experience providing social service case management; OR 3 years of experience providing social service case management that included individual planning and delivery of health care services
* Must possess a current and valid Arizona driver’s license
* Experience with health care delivery systems and the use of appropriate channels to deliver health care services
* Understanding of various medical interventions that pertain to the customer’s diagnosis
At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
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.