Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.

Responsible for developing and maintaining an integrated biopsychosocial program that achieves required service standards by measuring performance against goals/metrics, directs the flow of work, and identifies opportunities for process and clinical improvements that are data-driven. This position works as part of the Integrated Care Leadership team.

  • Research, assess, develop, document and evaluate  biopsychosocial health management programs for members in compliance with applicable BCBSAZ benefit plans, state, federal and accreditation guidelines.
  • Plan 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
  • 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
  •  Research, prepare and present executive level materials to include but not limited to subject specific white papers, business case documents, PowerPoint presentations
  • 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 employees and new processes.
  • Support the Integrated Care Leadership and staff with integration activities.
  • 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 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.

 

 

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.

Skills / Requirements

  1. Required Work Experience
 
  1. Preferred Work Experience
  • 5 -7 years of experience in health insurance field
  • 3 years of experience in full-time equivalent of  integrated or behavioral health direct clinical care to the consumer
 
  1. 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.
  1. Preferred Certifications
  • Active and current certification in case management (CCM), Certified Professional in Healthcare Quality (CPHQ) or other health related certification.
  1. Required Job Skills
    • Experience developing  data driven programs / management
    • Experience developing measures and outcomes to determine cost savings
    • Experience in project management and program implementation
    • Knowledge of issues related to mental health / substance use
    • Intermediate knowledge of information systems including Microsoft office suites plus public and proprietary software applications
    •  
  1. Required Professional Competencies
    • Maintain confidentiality and privacy in consideration of State, Federal, BCBSAZ and other accreditation requirements
    • Analytical knowledge to generate reports based on available data and make decisions based on reported data
    • Capable of investigative and analytical research as well as presenting results to stakeholders in a format that facilitates fact based decision making
    • Practice interpersonal and active listening skills to achieve customer satisfaction
    • Skill in composing a variety of business correspondence
    • Ability to 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 Departments/Divisions
    • Organizational skills with the ability to prioritize tasks and work with multiple priorities
    • Independent and sound judgment with good problem solving skills
  1. Required Leadership Experience and Competencies
    • Superior communication and conflict resolution skills
    • Represent BCBSAZ in the community
    • Make use of employee’s skills and abilities to deliver business objectives
    • Use available information to focus the team’s activities and identify priorities
 

Application Instructions

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