Registered Nurse CM Clinical Specialist (prior experience with Case Mgmt URAC, NCQA with a health plan preferred)
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 supporting the Care Management Department by providing professional oversight with an emphasis on URAC accreditation, Health Management System workflow configuration and documentation, Case and Utilization Management , and compliance with State, Federal, BCBSAZ and accreditation guidelines/regulations.
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
Preferred Work Experience
3 years of experience in clinical field of practice, health insurance, or other health care related field
2 years of experience working on healthcare-related systems
1 year of experience leading improvement projects
1 year of experience in data analysis
1 year of experience in accreditation