Director, Integrated Care Management - Hybrid

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.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This role is classified as a People Leader. Please see our in-office requirements for People Leaders within the job posting.

Purpose of the job

• Responsible for overseeing the Integrated Care Management department to ensure operations in compliance with clinical guidelines, contractual, accreditation, and regulatory requirements for all business segments.

REQUIRED QUALIFICATIONS

Required Work Experience

• 10 years of experience in a clinical field of practice, health insurance, or other healthcare setting/field
• 5 or more years leading a team of at least five clinical professionals in a clinical or managed care setting
• 5 years relevant case management and/or condition management experience and current clinical knowledge
• Experience in developing and executing operational strategies that result in improved member outcomes, increased service levels, and clinical efficiencies

Required Education

• Bachelor’s degree in nursing, healthcare administration, public health, social work or health related field

Required Licenses

• Active, current and unrestricted license to practice in Arizona as a health professional

Required Certifications

• Within 3 years of hire, hold a certification in case management from one of the following: Certified Case Manager (CCM), Case Management Administrator Certified (CMAC), Case Management Certified (CMC), Registered Nurse Case Manager, or other approved related certification

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 7 years or more leading a department of 10 or more staff in a clinical or managed care setting
• 5 years experience in data collection, analysis and reporting

Preferred Education

• Master’s degree in healthcare administration, public health, nursing, social work or other health related field

Preferred Licenses

• Active, current and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN.

Preferred Certifications

• Case Management Certification

ESSENTIAL job functions AND RESPONSIBILITIES

• Manage and oversee all staff activities related to the development and delivery of the Integrated Condition Management department across all business segments to ensure program interventions, goals and targeted outcomes are integrated with systems/processes and in alignment with strategic initiatives.
• Lead the Integrated Care Management department strategic planning activities under the direction of clinical leadership and contribute to the achievement of BCBSAZ’s Make Arizona Healthier goals.
• Promote integrated, whole-person, member-centric approaches to care management.
• Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other regulatory/accreditation requirements.
• Develop work plan, annual budget, and operating plan to support the department, ensuring appropriate budgetary oversight and financial stewardship of administrative dollars.
• Provide oversight and recommendation on cases being managed by program staff.
• Assess the overall performance of the program and make strategic recommendations for improvements.
• Provide education on the program to internal staff and BCBSAZ clients.
• Prepare and present executive level materials on the department’s strategies, successes, and opportunities.
• Maintain relevant care management vendor relationships and provide oversight to the program and its outcomes.
• Ensure Care Management interventions are incorporated into policies, committees, and operational procedures and coordinate activities between multiple divisions to achieve desired results.
• Oversee delivery of population health reporting to business segments, employer groups, clinical leadership and applicable committees.  Ensure benchmark data, best and finals and other presentation materials are accurate, complete and aligned with the strategic needs of the client and BCBSAZ.
• Provide RFP/RFI responses as they pertain to care management inquiries. 
• Identify internal and external stakeholders with needs related to the Care Management department and develop education geared towards managing and improving health outcomes with the effective management of costs.
• Maintain and monitor the delivery and effectiveness of the Care Management department, identify solutions to challenges and implement improvements.
• Ensure maintenance of complete and accurate records per department policy
• Interview, evaluate, and make recommendations regarding employment decisions
• Participate in training Care Management employees for both new employees and new processes.
• Explain to customers and business partners a variety of information concerning the organization’s 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 medicine, care/case management, and managed care at least annually.
• Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.
• Volunteer within the community to help BCBSAZ give back to community charitable efforts.
• Ability to travel up to 25% of time to attend work related business meetings, trainings and conferences.
• 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 other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills

• Knowledge of program development/management
• Strong written and verbal communications. Excellent organizational skills and strong attention to detail
• Experience with giving presentations; educational sessions
• Possess proficient computer and technological skills especially Word, Excel, PowerPoint, SharePoint, and Internet
• Ability to gather, analyze data and prepare informative and accurate reports.
• Ability to understand the workflow of multiple components of the company and to assist in the creation and implementation of integrated policies, procedures, workplans and creative solutions.
• Ability to work and collaborate with multi-disciplinary teams and promotion of population health

Required Professional Competencies

• Advanced clinical knowledge, including knowledge of the case and utilization management process
• Ability to develop, organize, motivate, coordinate and collaborate effectively with stakeholders from multiple business areas across the organization
• Ability to successfully function in an environment characterized by risk taking, rapidly changing market conditions, strong competition and restructuring.
• Strong understanding of the costs/quality challenges of today’s health care environment.
• Ability to Interpret and translate policies, procedures, programs and guidelines
• Extensive knowledge of health and/or patient education, care/case management, and behavior change techniques
• Organizational skills to analyze, interpret data, synthesize, evaluate and explain educational concepts, practices and methodologies to staff and transfer data to and from written and verbal medium
• Maintain confidentiality and privacy in consideration of State, Federal, BCBSAZ and other accreditation requirements
• Practice interpersonal and active listening skills to achieve customer satisfaction
• Demonstrated organizational skills with the ability to priortize tasks and work with multiple priorities
• Deliver and follow instruction and direction
• Establish and maintain working relationships in a collaborative team environment
• Apply independent and sound judgment with good problem solving skilll

Required Leadership Experience and Competencies

• Utilize employees’ skills and abilities to meet business objectives and successfully implement program goals
• Use available information to direct team’s activities and prioritize work
• Develop and enhance a culture of inclusion, collaboration, and performance excellence
• Mindset geared toward creation, execution and continuous improvement.
• Ability to perform job role duties independently.
• Ability to professionally represent BCBSAZ in the community
• Resolve conflicts.

PREFERRED COMPETENCIES

Preferred Job Skills

• Advanced PC proficiency
• Knowledge of CPT/HCPCs and ICD-10 coding
• Knowledge of Tableau

Preferred Professional Competencies

• Experience in motivational interviewing
• Demonstrated ability to develop clinical programs that result in improved efficiencies and quality outcomes
• Project management experience
• Maintain current thorough knowledge of State, Federal, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions
• Working knowledge of Change Healthcare InterQual® and Milliman ® criteria/guidelines

Preferred Leadership Experience and Competencies

• Experience overseeing integrated care management program

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.