Serves as the liaison and interacts extensively with tribal nations and tribal providers, promoting services and programs to improve the health of American Indian members. Partners with market leadership and cross functional associates within the organization to develop and implement long range health program strategies. Serves as project manager for projects and initiatives which positively impact the health of American Indian members. Directs and facilitates American Indian training programs for associates, and external provider community. Assists with program and services development of policy and procedure, work flows and other documentation and product development activities.
DEPARTMENT: Medicaid Product
REPORTS TO: State President
- Project leads tribal nation program development and integration activities both internally and externally.
- Utilizes data to identify and manage change necessary to achieve performance improvement.
- Improves health of American Indian members by driving cross functional initiatives.
- Attends all AHCCCS Tribal Consultation meetings.
- Communicates and educates associates on tribal nations.
- Develops tribal nation educational materials and performs provider tribal nation education.
- Works to develop and enhance relationships within the provider community, that are participating in tribal nation activities.
- Designs, develops and implements tribal nation training for associates and providers.
- Educates health plan leadership and cross functional staff on tribal nation strategy ensuring all entities understand and support the initiatives.
- Produces professional presentations and training materials to be utilized for training of providers and associates.
- Manages tribal nation specific policy and procedure development, program descriptions, and other related documentation requirements.
- Conducts ongoing research related to health trends and assesses potential impact.
- Assists with analysis of program utilization data, KPI review and monitoring of metrics. Participates with development of corrective action plans and associated activities for areas that need improvement.
- Develops and delivers presentations and routine reports related to assigned projects.
- Performs other duties as assigned.
- Required a Bachelor's Degree in counseling, social work, psychology, nursing, or related human service field
- Preferred a Master's Degree in counseling, social work, psychology, nursing, or related human service field
- Required 5 years of experience in Health care administration (physician/provider relations, program administration, contract administration)
- Preferred managed care experience
- Required 3 years of experience in State, Federal and Tribal governments. Understands tribal sovereignty, systems of care, and access to care for American Indian members.
Licenses and Certifications:
- Intermediate ability to lead/manage others in a matrixed environment
- Intermediate demonstrated project management skills
- Intermediate ability to work independently
- Intermediate ability to work as part of a team
- Intermediate strong people skills
- Intermediate ability to apply Lean/Six Sigma industry standard application and methodologies preferred
- Intermediate comfortable presenting in front of large groups
- Intermediate ability to redefine business approaches and processes to meet objectives
- Intermediate ability to think outside the box, structure an ambiguous opportunity, determine ROI and build business case for projects
- Intermediate possess strategic enterprise wide view while maintaining attention to detail
A license in one of the following is required:
- Preferred Licensed Clinical Social Worker (LCSW)
- Required advanced Microsoft Word
- Required advanced Microsoft Excel
- Required advanced Microsoft PowerPoint
- Required advanced Microsoft Project
- Required advanced Microsoft Outlook
- Required intermediate Healthcare Management Systems (Generic)