locations
Phoenix
time type
Full time
posted on
Posted 30+ Days Ago
job requisition id
R5145
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
Bachelor’s Degree in Nursing or master’s 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
Master’s 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. Click Here : Apply Now