• Responsible for executing and monitoring the management of company implementation processes in corporate systems. • Ensure data integrity between our clients (HR), carriers/insurers and Alper through data reconciliations and audits. • Actively handle operational requests from internal and external clients using tools provided by Alper. • Responsible for ensuring the efficiency, integrity and continuous improvement of enrollment and transaction processes. • Work strategically by conducting critical analyses, proposing solutions and supporting management in decision-making.

Role Description Trillium Health Resources has a career opening for a Prepayment Review Clinician to join our team! The Prepayment Review Clinician is responsible for maintaining knowledge of applicable Federal, State, and Accreditation requirements and ensuring providers, vendors, and Trillium maintain compliance with these requirements through internal and external reviews. On a typical day, you might: - Conduct clinical portions of the Prepayment Claims Review to ensure provider network and agency compliance with applicable laws and regulations prior to payment. - Ensure all timeframes associated with Prepayment Claims review are identified, monitored, and met by the team throughout the process. - Provide appropriate communication, both verbally and written, throughout the Prepayment Claims Review process with internal departments and external agencies, as appropriate. - Assist with tracking logs related to Prepayment Claims Reviews. - Maintain all documentation related to Prepayment Claims Review activities. Qualifications - Master’s degree. - Minimum one (1) year of experience with behavioral health, mental health, substance abuse, developmental disabilities, and/or co-occurring disorders populations or field. - Fully licensed by the State of North Carolina as a LCMHC, LMFT, LCSW, LCAS, or RN. - Must have a valid driver’s license. - Must reside within North Carolina. - Must be able to travel within catchment as required. Requirements - Experience in any of the following areas: healthcare compliance, knowledge of North Carolina Clinical Coverage Policies and billing requirements related to Medicaid, knowledge and understanding of Prepayment Review Process, public speaking, mediation and/or problem resolution, group facilitation, advocacy, and project management. - Certified in Healthcare Compliance (CHC), Accredited Health Care Fraud Investigator (AFHI), Certified Fraud Examiner (CFE), or equivalent certifications. Benefits - Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval. - Work-from-home options available for most positions. - Health Insurance with no premium for employee coverage. - Flexible Spending Accounts. - 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year. - NC Local Government Retirement Pension (defined-benefit plan). - 401k with 5% employer match and immediate vesting. - Public Service Loan Forgiveness (PSLF) qualifying employer. - Quarterly stipend for remote work supplies. Company Description Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

AHCCCS Arizona Health Care Cost Containment System Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork 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. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. 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. Come join our dynamic and dedicated team. Compliance Project Manager Division of Managed Care (DMC) Job Location: Address: 150 North 18th Avenue Phoenix, Arizona 85007 All AHCCCS Employees must reside within the state of Arizona. Posting Details: Salary: $76,450 - $78,100 Grade: 22 FLSA Status: Exempt This position will remain open until filled. Job Summary: The position is responsible, along with a team of individuals in the Operations Unit, for having a comprehensive understanding of federal and state regulation guiding the provision of managed care and for ensuring that all AHCCCS managed care organizations/contractors adhere to all applicable regulations as well as all requirements outlined in contract and in AHCCCS policy. Major duties and responsibilities include but are not limited to: • Represent AHCCCS at meetings with contractors and other contractor professionals; participate in special projects related to Medicaid managed care, including rules teams, fraud prevention, contract development, audits, compliance reviews etc. • Monitor, evaluate and prepare responses, as applicable, for contractor deliverables and/or conduct provider network availability/accessibility monitoring. • Organize and coordinate services and communication among AHCCCS divisions and contractors for the purpose of identifying, resolving, and monitoring contractor compliance issues. • Interpret various administrative rules, regulations, policies, and procedures. • Prepare responses to contractors, state agencies, and others requesting technical assistance or expressing a concern or complaint related to the acute, integrated physical and behavioral health, and long-term care programs. • Provide technical assistance to contractors, providers, members, and other internal and external customers. • Monitor and evaluate the development of new contractors who successfully bid for acute, integrated physical and behavioral health, and long-term care services. • Produce written policies, procedures and reports for the acute, integrated physical and behavioral health and long-term care programs. Knowledge, Skills & Abilities (KSAs): Knowledge: • Project management methodology • Techniques to select a particular approach to analyze, develop or implement policy • Statistical analysis, data analysis, and research methods • Managed care principles and delivery systems • Acute, behavioral health and long term care management principles and operations • AHCCCS statutes and rules • Problem solving and technical writing • AHCCCS contract requirements and policies, including but not limited the AHCCCS Medical Policy Manual, the AHCCCS Contractor Operations Manual, the AHCCCS Claims Dashboard, and the AHCCCS Grievance and Appeal System Reporting Guide • Computer skills including Microsoft OneDrive, Word, Access, Excel, PowerPoint and Microsoft Suite Products Skills: • Organizational skills that result in prioritization of multiple tasks • Conflict resolution • Excellent oral and written communication skills Abilities: • Draft, implement and interpret rules, laws and agency policy pertaining to the Medicaid managed care delivery system • Analyze problems and develop effective plans for corrective action • Communicate effectively with all levels of professionals, corporate and agency officers, providers and members • Provide effective guidance and technical assistance regarding Medicaid managed care issues and the administration of AHCCCS programs • Effectively lead and/or facilitate a team of professionals from within and/or outside the agency • Produce effective written communication. • Multi-task in a fast-paced environment. • Produce work products with limited supervision Qualifications: Minimum: • Two (2) to three (3) years of experience in Medicaid service delivery (acute, long-term care and/or behavioral health services). Preferred: • Bachelor's or higher degree in Public Health, Social Work or Public Administration or closely related field. Pre-Employment Requirements: • 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 R2-10-207.12.) 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: Driver’s License Requirements. 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. Learn more about the Paid Parental Leave pilot program here. • 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 program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page 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. Contact Us: Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov. Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.

• Oversee department staff including hiring, performance management and career development to ensure alignment with defined goals • Develop budgets and priorities, ensuring plans and resource allocations are consistent with those budgets and priorities • Determine the organization’s long-term systems and/or hardware needs to accomplish the organization’s business objectives • Analyze the needs of departments and establish priorities for feasibility studies, systems design, and implementation to develop new and/or modify the company’s information processing systems and policies and procedures • Responsible for the plans and activities of the organization with senior leaders inside and outside IT, as well as strategic suppliers • Apply process and business expertise to impact business results