MAXIMUS

  • Grievance System Administrator - Attorney

    Job Locations US-AZ-Phoenix
    Posted Date 1 week ago(4/9/2018 6:01 PM)
    Requisition ID
    2018-31008
    # of Openings
    1
    Job Function
    Appeals
    Job Schedule
    Regular Full-Time
  • Project/Position Introduction

    MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS’s founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.

    Overview

    *Role is contingent upon bid award*

     

    REMOTE OPPORTUNITY - This role is 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.

    The Senior Consultant - Appeals will provide senior level analysis of processes, techniques and procedures of cases in applying experience to ensure the appropriate practical determination is reached.

    Responsibilities

    • 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

    The Ideal Candidate will Possess the Following Additional Education and Experience

    • Juris Doctor from an accredited law school; Must be a licensed attorney
    • Two to three years experience in law office or applicable experience
    • Ability to conduct comprehensive research in law and health policy
    • Excellent organizational, interpersonal, written, and verbal communication skills
    • Ability to successfully execute many complex tasks simultaneously
    • Ability to work as a team member, as well as independently
    • Demonstrate and promotes positive company relations
    • Proficiency in Microsoft Word and Excel and Internet research
    • Litigation experience preferred
    • Legal writing experience preferred
    • Advanced health-related degree is desirable
    • Minimum of five (5) years experience interpreting and applying Medicaid regulations is desirable

     

    EEO Statement

    EEO Statement
    Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you

    A committed and diverse workforce is our most important resource.

    MAXIMUS is an Affirmative Action/Equal Opportunity Employer.

    MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

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