Clinical Program Specialist (AZ Remote)

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 position is remote/hybrid within the state of AZ only

PURPOSE OF THE JOB

Responsible for the development, implementation and oversight of projects and programs related to AHCCCS Childrens System of Care. This position serves as liaison and single point of contact for population and assigned programs.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

2 years of experience in direct interaction with members in a behavioral health or social work setting

2. Required Education

Bachelors Degree in a behavioral health related field

3. Required Licenses

Valid Arizona Driver License, with an acceptable driving record

4. Required Certifications

N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

5 years of experience in direct interaction with members in a behavioral health or social work setting

2. Preferred Education

Masters Degree in a behavioral health related field

3. Preferred Licenses

N/A

4. Preferred Certifications

N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Coordination of care between Medicaid Business Segment providers and community stakeholders, facilitating access to care, case consultation, program development and assisting in the design of integrated health activities and services for members of various populations/programs

Provides subject matter expertise to internal and provider clinical teams for the above populations/programs

Provides specific case consultation, technical assistance, and/or participates, as appropriate, in clinical care teams

Assists in the development of various projects and programs related to transition to adulthood, including conducting gap analyses and developing project standards, policies, procedures, protocols and monitoring of transition age

youth services for the greater Medicaid Business Segment GSA

Involvement in development, implementation and monitoring of Center of Excellence for Transition Age Youth

Oversight, capacity monitoring, technical assistance and program development

Development and implementation of Child and Family Team policy and training

Consultation with providers, stakeholders, Medicaid Business Segment and AHCCCS

Monitors identified populations and programs to ensure compliance with Medicaid Business Segment state and federal regulations

Performs clinical oversight functions such as reviewing of criteria-based clinical activities, processes or programs for adherence to established standards or criteria, and/or information gathering in a timely manner

Responsible for program, policy, and report development/deliverables for Medicaid Business Segment its stakeholders and AHCCCS for populations and programs indicated

Maintains and updates programmatic data and policies for AHCCCS, System of Care and Medicaid Business Segment reporting

Coordinates, facilitates and/or participates in state, regional and local planning and development meetings for populations and programs indicated

Coordinates with Performance Improvement Unit and acts as a subject matter expert in Childrens System of Care Practice Reviews and Performance Improvement Plan development and implementation

Travel in central and northern Arizona

Perform all other duties as assigned

The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

Knowledge of AHCCCS contract requirements, policies and procedures

Knowledge of AZ Childrens System of Care and Child and Family Team requirements

Knowledge of the AZ Integrated Health Plan/Managed Care Organization Model

Experience in coordinating care for individuals with complex behavioral health needs

Ability to develop, prioritize and manage multiple projects for program development and evaluation

Ability to develop and present educational programs and/or presentations for contracting agencies, Medicaid Business Segment Leadership and AHCCCS Leadership

Knowledge of and the ability to comply with ethical and legal issues surrounding member rights, confidentiality, reporting abuse and the maintaining privacy and security of protected health information

Ability to organize and prioritize work to meet contractual deadlines

Knowledge of computer applications for word processing and spreadsheets

2. Required Professional Competencies

Strong team member with demonstrated ability to inspire and motivate stakeholders with effective communication both verbally and in writing; and the ability to work effectively and efficiently either as a team member or independently

Skill in mediation and conflict resolution

3. Required Leadership Experience and Competencies

N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

N/A

2. Preferred Professional Competencies N/A 3. Preferred Leadership Experience and Competencies N/A

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.