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, 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

  • Associate’s 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

  • Bachelor’s or Master’s 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

ESSENTIAL job functions AND RESPONSIBILITIES
  • 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 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

REQUIRED COMPETENCIES

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/Mental Health Parity
  • Intermediate knowledge of information systems including Microsoft office suites plus public and proprietary software applications
  • Experience with technical/legal writing
  • Project Management experience
  • Experience with leading large scale cross functional or cross departmental projects or audits
  • Skills in translating data into actionable information

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

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

PREFERRED COMPETENCIES

Preferred Job Skills

  • Advanced PC proficiency e.g. use of SharePoint, Microsoft suite including Teams
  • Knowledge of CPT-4, ICD-10 and DSM-5 coding

Preferred Professional Competencies

  • Advanced knowledge, including knowledge of the care and utilization management process
  • Experience with quality improvement processes
  • Experience with program auditing
  • Maintain current thorough knowledge of State, Federal, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions
  • Working knowledge of McKesson InterQual®/MCG  criteria
  • Competency in tracking, managing and documenting complex projects with cross functional stakeholders
  • Shows initiative and provides strategic input into department planning
  • Ability to work with data science to translate data into meaningful actionable information

Preferred Leadership Experience and Competencies

  • Ability to motivate staff and stakeholders
  • Experience building a high performing team
  • Experience defining expectations and managing change

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

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.


Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll 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



Posted 30+ Days Ago

Full time

R728

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