Mgr. Pediatric Clinical Programs - Blue Cross Blue Shield of Arizona

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This is a hybrid position that requires work and residency within the state of Arizona.

Purpose of the job

Responsible for developing and managing the day to day processes required to provide Integrated Clinical Management activities that promote quality, cost effective outcomes and remain compliant with all regulatory requirements.

Additionally responsible for research, development, and improvement of prevention programs and strategies throughout the network. Responsibilities include developing collaborative partnerships with community and provider agencies, clinicians, and community members to identify resources; providing training and technical assistance to staff and providers; preparing reports; and monitoring providers for compliance with NCQA, state, and federal regulations. Conducts annual needs and capacity assessments.

REQUIRED QUALIFICATIONS

Required Work Experience

• 3 years experience in clinical care

• 2 -3 years experience in a supervisory role

Required Education

• Bachelors Degree in Nursing or masters degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.)

Required Licenses

• Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN) or independent license in the behavioral health profession such as LCSW, LPC, LISAC LMFT

Required Certifications

• Once they have directly supervised the integrated care process within (3) years with the organization, hold a certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).
  

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 5 years experience in full-time equivalent of direct clinical care to youth and adolescents
• Physical and behavioral health experience
• 3-4 years experience in a supervisory role
• 2-3 years of experience working in a managed care organization
• Program development
• Knowledge of population health concepts and models
• Knowledge of NCQA Standards

Preferred Education

• Masters Degree in Nursing

Preferred Licenses

• N/A

Preferred Certifications

Active and current certification in case management from the following certifications: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN-BC).

REQUIRED COMPETENCIES

Required Job Skills

• Intermediate skill in use of office equipment including copier, fax machine, scanner, and telephones
• Intermediate PC proficiency
• Intermediate skill in word processing, spreadsheet, and database software

• Excellent communication, collaboration, and delegation skills.
• Proficiency in project management
• Ability to think analytically to resolve issues; solution-focused mindset; creative and innovative
• Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
• Ability to learn new applications
• Data analytics skills

Required Professional Competencies

• Maintain confidentiality and privacy in consideration of State, Federal, BCBSAZ and other accreditation requirements
• Advanced and current clinical knowledge
• Demonstrates knowledge and understanding of the medical management process
• Analytical knowledge necessary to generate reports based on available data and the ability to make decisions based on reported data
• Capable of investigative and analytical research
• Practice interpersonal and active listening skills to achieve customer satisfaction
• Compose a variety of business correspondence
• Interpret and translate policies, procedures, programs and guidelines
• Navigate, gather, input and maintain data records in multiple system applications
• Establish and maintain working relationships in a collaborative team environment with all BCBSAZ Departments/Divisions
• Organizational skills with the ability to prioritize tasks and work with multiple priorities
• Independent and sound judgement with good problem solving skills

Required Leadership Experience and Competencies

• Make use of employee's skills and abilities to deliver business objectives
• Use available information to focus team's activities and identify priorities
• Ability to develop and build a high performing team culture

PREFERRED COMPETENCIES

Preferred Job Skills

• Advanced PC proficiency

Preferred Professional Competencies

• Maintains current knowledge of State, Federal, BCBSAZ, and other applicable regulatory/accrediting agency requirements as they apply to department functions

Preferred Leadership Experience and Competencies

• Demonstrates effective presentation skills
• Demonstrated effective leadership skills

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.