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Years of Experience
Date Last Verified
Grievance System Administrator - Attorney The candidate will primarily responsible for managing, overseeing, implementing and administering all grievance processes and requirements. When appropriate, participates in face-to-face meetings with appellants and fair hearings to clarify and support Serious Mental Illness determinations. Oversees reviews of all submitted appeals and completion of post-adjudication determination decision letters. Assists in legal analysis and provides coaching and procedural instructions for variety of staff as requested. Will also serve as the Policy Subject Matter Expert (SME) for all legal appeal and grievance related issues. Appeals will provide senior level analysis of processes, techniques and procedures of cases in applying experience to ensure the appropriate practical determination is reached. Oversee gathering of information for appeal case records; oversee maintenance and updates to records. Manage proper preparation and delivery of notices to all associated parties for each grievance and appeal. Manage overall appeals and grievance timelines according to Arizona policies and procedures. Attend and oversee informal conference with appellant. Ensure appellant has advocate assigned and work with Human Rights Office to coordinate assignment. Prepare statement regarding nature, issues involved, resolutions and unresolved items. Prepare/oversee appropriate follow-up actions. Ensure proper filings of requests for hearings with AHCCCS. Provide clear understanding to appellant of rights to informal conference with AHCCCS and coordinate informal conference. Oversee closure of appeals case and notification. Oversee expedited appeals as requested by appellants, including informal conferences and hearings. Participate in informal hearings with AHCCCS as requested. Responds to outside inquiries of concerns regarding determinations. Performs special projects not related to a specific case such as general legal research; general medical research, drafting proposal sections or acting as a liaison for a specific project. Performs other duties as assigned by management.
Qualification and Experience
The candidate should have Juris Doctor from an accredited law school. Must be a licensed attorney. Must have 2-3 years of experience in law office or applicable experience. Ability to conduct comprehensive research in law and health policy is required. Excellent organizational, interpersonal, written, and verbal communication skills is required. Proficiency in Microsoft Word and Excel and Internet research is required. Litigation experience preferred. Legal writing experience preferred. Advanced health-related degree is desirable. 5+ years of experience interpreting and applying Medicaid regulations is desirable.
Requisition ID 2018-31008
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