Clinical Program Specialist (AZ Remote)

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.

This position is remote/hybrid within the state of AZ only

PURPOSE OF THE JOB

Responsible for the development, implementation and oversight of projects and programs related to AHCCCS Children’s System of Care. This position serves as liaison and single point of contact for population and assigned programs.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 2 years of experience in direct interaction with members in a behavioral health or social work setting

2. Required Education

· Bachelor’s Degree in a behavioral health related field

3. Required Licenses

· Valid Arizona Driver License, with an acceptable driving record

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· 5 years of experience in direct interaction with members in a behavioral health or social work setting

2. Preferred Education

· Master’s Degree in a behavioral health related field

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· Coordination of care between Medicaid Business Segment providers and community stakeholders, facilitating access to care, case consultation, program development and assisting in the design of integrated health activities and services for members of various populations/programs

· Provides subject matter expertise to internal and provider clinical teams for the above populations/programs

· Provides specific case consultation, technical assistance, and/or participates, as appropriate, in clinical care teams

· Assists in the development of various projects and programs related to transition to adulthood, including conducting gap analyses and developing project standards, policies, procedures, protocols and monitoring of transition age

youth services for the greater Medicaid Business Segment GSA

· Involvement in development, implementation and monitoring of Center of Excellence for Transition Age Youth

· Oversight, capacity monitoring, technical assistance and program development

· Development and implementation of Child and Family Team policy and training

· Consultation with providers, stakeholders, Medicaid Business Segment and AHCCCS

· Monitors identified populations and programs to ensure compliance with Medicaid Business Segment state and federal regulations

· Performs clinical oversight functions such as reviewing of criteria-based clinical activities, processes or programs for adherence to established standards or criteria, and/or information gathering in a timely manner

· Responsible for program, policy, and report development/deliverables for Medicaid Business Segment its stakeholders and AHCCCS for populations and programs indicated

· Maintains and updates programmatic data and policies for AHCCCS, System of Care and Medicaid Business Segment reporting

· Coordinates, facilitates and/or participates in state, regional and local planning and development meetings for populations and programs indicated

· Coordinates with Performance Improvement Unit and acts as a subject matter expert in Children’s System of Care Practice Reviews and Performance Improvement Plan development and implementation

· Travel in central and northern Arizona

· Perform all other duties as assigned

· 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

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Knowledge of AHCCCS contract requirements, policies and procedures

· Knowledge of AZ Children’s System of Care and Child and Family Team requirements

· Knowledge of the AZ Integrated Health Plan/Managed Care Organization Model

· Experience in coordinating care for individuals with complex behavioral health needs

· Ability to develop, prioritize and manage multiple projects for program development and evaluation

· Ability to develop and present educational programs and/or presentations for contracting agencies, Medicaid Business Segment Leadership and AHCCCS Leadership

· Knowledge of and the ability to comply with ethical and legal issues surrounding member right