Integrated Care Program Development Coordinator

• Responsible for developing, implementing and overseeing cross functional and cross departmental activities that ensure and document compliance with Mental Health Parity Addiction Equity Act and all of its final rules. Develops and directs all preparation for deliverables, audits and responses to inquiries and complaints that relate to MHPAEA
• Responsible for supporting the development and maintenance of an integrated biopsychosocial clinical program that demonstrates achievement of required service standards, achieves clinical goals and metrics, and identifies opportunities for process and clinical improvements that are data-driven
• This position is an integral part of the Integrated Care Leadership team.

REQUIRED QUALIFICATIONS

Required Work Experience

• 3 years of experience in clinical field of practice

• 3 years in health insurance, with a detailed understanding of health plan functions in medical management, network and benefits.
• 2 years experience in one or more of the following areas: writing health plan policies, health plan internal audit,
• documentation of quality processes, and/or
• 2 years experience with organization- wide accreditation (URAC, NCQA), and/or
• 2 years of experience with performing Delegation Oversight activities

Required Education

• Associates degree in a health related field such as nursing, behavioral health, public health, etc.

Required Licenses

• NA

Required Certifications

• N/A
  

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 3 years of experience in providing leadership or held an influential role within a medical/health management division of a health insurance organization
• 3 years of vendor management or oversight experience

Preferred Education

• Bachelors or Masters degree in a health related field such as nursing, behavioral health, public health, etc.

Preferred Licenses

• Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including RN, LPC, LMFT or LCSW.

Preferred Certifications

• Certified Professional in Healthcare Quality (CPHQ) or other health related certification
• Certification in Project Management

• MHPAEA Compliance
  • Lead and participate in all activities related to MHPAEA documentation review and maintenance
  • Lead and participate in the preparation of materials to support MHPAEA compliance for state and federal regulators
  • Track and prepare responses to MHPAEA complaints and inquiries
  • Use effective leadership and project management skills to mobilize subject matter experts across multiple teams

• Program Management Coordination and Support
  • Research, assess, develop, document and evaluate biopsychosocial health management programs for members in compliance with applicable BCBSAZ benefit plans, state, federal and accreditation guidelines
  • Assist in the delivery of the overall integrated program and its activities based on data and evidence based practices in accordance with the mission and the goals of the organization
  • With the Data Science team and Integrated Care Leadership, develop and implement outcomes metrics, long-term goals and objectives to achieve program success
  • Develop a program evaluation framework to assess the strengths of the program and to identify areas for improvement; Track and report program outcomes
  • Ensure that program activities operate within the policies and procedures of the organization
  • Develop forms and records to document program activities
  • Support the oversight and performance of our vendor and value based partners
  • Participate, as needed, in oversight of partners delegated to perform Care Management
  • Oversee the collection and maintenance of records on the clients of the program for statistical purposes according to the confidentiality/privacy policy of the organization

• Integrated Care Leadership Team
  • Research, prepare and present executive level materials to include but not limited to subject specific white papers, business case documents, PowerPoint presentations, special topic talking points
  • Consult and coordinate with various internal departments, external plans, providers, vendors, businesses and government agencies to build collaboration, obtain information and gain stakeholder support to meet departmental projects and goals
  • Participate in training of Behavioral Health and Care Management employees for both new programs and new processes
  • Provide clinical support to the teams e.g. case consultation and resources as needed
  • Support the Integrated Care Leadership and staff with integration activities
  • Explain to customers and business partners a variety of information concerning the organizations services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
  • Participate in continuing education and current developments in the field of integrated and managed care at least annually
  • Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals
  • Maintain all standards in consideration of State, Federal, FEP, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions
• 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
• Perform all other duties as assigned

Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. Thats the kind of satisfaction youll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross BlueShield of Arizona