PROGRAM ADMINISTRATOR III

The Program Administrator III position is an RHTP grant funded position for a period of 1 year. The grant totals under $130,000, with internal funds covering any excess costs.

The Program Administrator III position serves as a trusted resource and primary point of contact for healthcare providers, health insurers, state agencies, and community stakeholders, fostering collaborative relationships to address regulatory, operational, and access-to-care challenges impacting Arizona's healthcare system.

In addition the Program Administrator III leads provider outreach and engagement efforts to educate stakeholders on state and federal insurance requirements, facilitate resolution of payer-provider concerns, enhance regulatory transparency, and reduce administrative burdens affecting healthcare delivery.

The Program Administrator III will partner with healthcare organizations, insurers, AHCCCS, ADHS, legislative stakeholders, and governmental agencies to identify systemic issues, support development of practical solutions, and advance agency initiatives that improve provider experience and consumer access to care.

The Program Administrator III also supports leadership through policy research, stakeholder communication, legislative and regulatory monitoring, performance reporting, and coordination of high-priority projects while exercising sound judgment, professionalism, and diplomacy in managing sensitive and complex provider-related matters.

• Direct and Educate healthcare providers, including physicians (MD/DO), nurse practitioners (NP), physician assistants (PA), dentist (DDS), hospital and health systems on state and federal insurance laws, complaint procedures and available avenues for assistance, leveraging Department of Insurance and Financial Institution resources to reduce administrative burdens and improve compliance. Assist healthcare providers in navigating credentialing and network participation requirements by providing guidance throughout the credentialing process identifying recurring administrative barriers, and facilitating timely and effective solutions to support provider access, participation, and compliance. Guide healthcare providers in understanding and managing appeals and grievance processes by providing information on procedural requirements. Support healthcare providers in understanding the requirements and dispute resolution options under the Federal No Surprises Act. Provide guidance to healthcare providers regarding network adequacy and access to behavioral health services. Provide guidance and assistance to healthcare providers regarding provider complaints by explaining applicable processes

• Identify recurring compliance questions and operational challenges affecting healthcare providers, particularly those serving rural Arizona communities, and facilitate solutions through provider guidance, resource coordination, and the navigation of available avenues for assistance. Identify opportunities to improve provider-facing guidance, complaint routing, outreach materials, and administrative processes within the department by evaluating existing practices and recommending enhancements to support effective service delivery and operational efficiency. Support departmental initiatives that advance transparency and effective communication between insurers and healthcare providers by promoting understanding of applicable requirements, facilitating information sharing, and providing guidance on available resources, processes, and avenues for assistance. Guide healthcare providers through regulatory frameworks related to payer and provider operations, including timely payment of claims, prior authorization requirements, healthcare appeals, provider grievances, surprise billing regulations, network participation, and Pharmacy Benefit Manager (PBM) interactions, by providing guidance, information, and access to available resources and avenues for assistance. Guide healthcare providers on coverage mandates and related requirements, including telehealth services, continuity of care, prescription drug exceptions, network adequacy, and behavioral health parity and access, by providing guidance, information, and access to available resources and avenues for assistance

• Execute proactive outreach strategy to healthcare providers and hospitals in rural and under-served Arizona communities, building and maintaining collaborative relationships, identifying and resolving insurance-related barriers, providing education, technical assistance, and ongoing support to enhance provider engagement and improve access to healthcare services

• Coordinate across internal DIFI divisions to resolve systemic provider friction, collaborating with provider liaisons at AHCCCS and ADHS to address mutual concerns, share best practices, align organizational goals, and avoid duplication of efforts while directly engaging health insurers to resolve escalated compliance and administrative disputes. Maintain professional, responsive, and impartial working relationships with providers, insurers, professional associations, and healthcare stakeholders to support effective collaboration and regulatory compliance. Track provider-impacted legislation in coordination with the DIFI Legislative Liaison, monitoring legislative and regulatory developments affecting healthcare providers, supporting stakeholder awareness, and facilitating communication to promote alignment with evolving policy and compliance requirements

• Maintain detailed metrics on outreach engagement, case resolution, and provider trends. Deliver regular reports to the DIFI Director and fulfilled statutory and ISA reporting requirements for AHCCCS, supporting program accountability, performance monitoring, and compliance with regulatory obligations

• Support National Association of Insurance Commissioners (NAIC) committees and meetings through policy research, briefing preparation, and meeting coordination; monitor regulatory developments, facilitate communication among providers and stakeholders, and identify provider impacts to support effective engagement. informed decision-making and alignment with national insurance regulatory initiatives

• Coordinate provider-related requests, deliverables, and stakeholder initiatives; track activities, facilitate communication among providers, state agencies, and internal partners, and support timely issue resolution to advance agency priorities and improve provider engagement

• Conduct research and prepare briefing materials, presentations, and outreach resources for provider meeting, stakeholder engagement, and educational initiatives, ensuring accurate, timely, and well-developed content to support provider engagement, informed decision-making, and effective communication of regulatory and programmatic information

• Other duties as assigned as related to the position

Knowledge:

• Federal and State healthcare insurance laws, regulations, and regulatory frameworks governing commercial health insurers and healthcare providers

• Federal No Surprises Act, network adequacy requirements, behavioral health access standards, telehealth regulations, continuity of care requirements, and healthcare consumer protections

• Provider credentialing, network participation requirements, claims adjudication processes, prior authorization requirements, appeals, grievances, and dispute resolution procedures

• Healthcare delivery systems, provider networks, healthcare reimbursement methodologies, and payer-provider relationships

• Legislative processes, governmental operations, public administration principles, and public policy

Skills:

• Developing and maintaining effective working relationships with executive leaders, healthcare providers, insurers, legislators, and governmental partners

• Communicating complex information clearly and effectively to diverse audiences, both verbally and in writing

• Analyzing complex regulatory, operational, legislative, and policy issues and developing practical solutions

• Preparing executive briefings, reports, presentations, speeches, policy papers, and correspondence

• Strategic thinking, problem-solving, and exercising sound judgment in high-profile situations

• Facilitating discussions, negotiating solutions, and resolving sensitive stakeholder concerns

• Managing multiple priorities, projects, and deadlines in a fast-paced environment

Ability:

• Establish credibility and influence with diverse stakeholder groups while maintaining professionalism, neutrality, and confidentiality

• Lead cross-functional initiatives and coordinate efforts among multiple agencies, organizations, and stakeholder group

• Analyze complex healthcare, insurance, regulatory, and public policy issues and develop strategic recommendations

• Foster collaboration, build strategic partnerships, and achieve results through influence rather than direct authority

• Communicate effectively with executive leadership, policymakers, healthcare professionals, and the public

• Manage competing priorities while maintaining attention to detail and achieving organizational objectives

• Exercise considerable independent judgment, discretion, and political acumen in sensitive situations

• Interpret and explain complex laws, regulations, and policies in a clear and understandable manner

• Identify systemic challenges, anticipate emerging issues, and proactively develop solutions

Required Education, Licensure, Certification

• Bachelor's degree from an accredited college or university in Public Administration, Business Administration, Healthcare Administration, Health Policy, Public Policy, Political Science, Government, Communications, Law, Insurance, or a closely related field

Preferred Education, Licensure, Certification

• Healthcare Administration (MHA), Public Policy, Health Policy, Organizational Leadership, Government Affairs, or a closely related field

• Employees who drive on state business are subject to driver’s license record checks, must maintain acceptable driving records and must complete any required driver training (see Arizona Administrative Code R2-10-207.12.)

• Requires possession of and ability to retain a current, valid state-issued driver’s license appropriate to the assignment

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.

The State of Arizona offers a comprehensive benefits package to include:

• Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

• Life insurance and long-term disability insurance

• Vacation with 10 paid holidays per year

• Health and dental insurance

• Retirement plan

• Sick leave

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

• Positions in this classification participate in the Arizona State Retirement System (ASRS)

• Note that enrollment eligibility will become effective after 27 weeks of employment

• If you have any questions please feel free to contact Gio Espinosa at gio.espinosa@difi.az.gov for assistance