Supervisor, Pediatric Clinical Programs

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ 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 developing and managing the day-to-day processes required to provide Integrated Clinical Management activities that promote quality, cost-effective outcomes, and comply with all regulatory requirements. 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 The Supervisor, Pediatric Clinical Programs leads a staff comprising of clinical and nonclinical members. The position is focused on ensuring the Care Management department achieves required service standards by measuring team performance against goals/metrics, directing the flow of work, and identifying opportunities for process improvements while meeting the goals of the population health model.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

Minimum: 5 years of combined pediatric experience in nursing, behavioral healthcare, or health plan care management

1-2 years prior supervisory experience managing pediatric clinical and non-clinical teams

2 years experience in direct pediatric clinical care

2. Required Education

Bachelors Degree in Nursing

3. 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)

4. 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

1. Preferred Work Experience

3 years experience in the full-time equivalent of direct clinical care to youth and adolescents

3 years experience in a clinical supervisory role

3 years of experience working in a managed care organization

Physical and behavioral health experience

Knowledge of population health concepts and models

Knowledge of NCQA Standards

2. Preferred Education Masters in Nursing

3. Preferred Licenses

N/A

REQUIRED COMPETENCIES

1. 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

2. 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 judgment with good problem-solving skills

3. Required Leadership Experience and Competencies

Make use of employee's skills and abilities to deliver business objectives

Use available information to focus on the team's activities and identify priorities

Ability to develop and build a high-performing team culture

PREFERRED COMPETENCIES

1. Preferred Job Skills Advanced PC proficiency

2. Preferred Professional Competencies

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

3. Preferred Leadership Experience and Competencies

Demonstrates practical presentation skills

Demonstrated practical leadership skills

4. Preferred Leadership Experience and Competencies

Demonstrated practical leadership skills

Demonstrates practical presentation skills

Our Commitment

BCBSAZ 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.