Job Description

Assists the Manager, Care Management-Precertification with performing duties to oversee day-to-day activities within the Care Management-Precertification Department to facilitate the achievement of business goals and targets.  Support management with leading Precertification team to ensure all types of precertification cases are completed in compliance with State, Federal, accreditation standards and other applicable regulations.

  • Assist with the development and review of l key workflows, policies and procedures and job aids at least annually. Under the direction of the Manager, Care Management-Precertification updates/revises workflows, policies and procedures and job aids as needed.
  • Assist with assigning work queues and oversight for key performance indicators
  • Oversee day-to-day activities, including inventory management to meet departmental and corporate timeliness standards
  • Assist with improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations
  • Maintain a thorough knowledge of evidence-based criteria and other policies
  • Assist with the validation and confirmation of follow through of the medical review decisions.
  • Assist with the development, execution and evaluation of desk level procedures and job aids
  • Assist with the reviewing, updating and accurate documentation, computer files, policies and procedures related to the departmental goals and objectives.
  • Assist with maintaining all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements
  • Assist with the implementation of quality assurance process, procedures, and measure for team activities.
  • Assist with providing motivation and encouragement to team.
  • Assist with interviews and candidate selection
  • This position requires a full-time work schedule
  • Performs all other duties as assigned
  • Assist leadership with deployment of strategic initiatives and Perceptyx plan.

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. Required Education
  • Associate’s Degree or Diploma in Nursing
  1. 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) current, and unrestricted State of Registered Nurse license
  1. Preferred Work Experience
    • 3 year(s) of experience in  clinical field of practice, health insurance, or other health care related field
    • 1 year(s) experience in a lead role
  1. Preferred Education
    • Bachelor's Degree in Nursing or business related field of study
  • Master’s Degree in Nursing or business related field of study
  1. Required Job Skills
  • Strong written and verbal communications. Excellent organizational skills and strong attention to detail
  • Possess proficient computer and technological skills especially Word, Excel, PowerPoint, SharePoint, Lync/Webinar, Internet and telephone including voice over internet protocol (VoIP)
    • Intermediate skill in use of office equipment, including copiers, fax machines, scanners Intermediate skill in word processing, spreadsheet and database software
    • Ability to gather, analyze data and prepare informative and accurate business reports
  1. Required Professional Competencies
    • Maintain confidentiality and privacy
    • Ability to set priorities
    • Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
    • Capable of investigative and analytical research
    • Practice interpersonal and active listening to achieve high customer satisfaction and departmental Practice communication standards
    • Establish and maintain working relationships in a collaborative team environment
    • Demonstrates ability to identify gaps, communicate gaps and propose possible solutions to close gaps to leadership
    • Ability to motivate, coordinate and collaborate effectively with team and stakeholders from multiple business areas
  1. Required Leadership Experience and Competencies
    • Make use of employees’ skills and abilities to deliver business objectives
    • Use available information to focus the team's activities and identify priorities.
    •  Resource management skills
    • Leadership  skills
    • Ability to empower employees and encourage innovation and risk taking  
    • The maturity, communication and influencing skills to assume a lead role in a growing, and changing organization.
    • Mindset geared toward the creation, execution and continuous improvement.



Application Instructions

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