Staff VP, Integrated Clinical Care - Hybrid

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.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

Purpose of the job

• Develop recommendations for innovation to existing clinical services to improve management of medical utilization and costs and using data to design, develop, and support implementation of clinical operations management programs as approved by Clinical Excellence leadership to meet the demographic and epidemiological needs of our members.  This includes high-cost claimants, system operations, and other special projects as assigned. 
• Oversee and manage delegated services including the current offshore UM vendor (Accenture) and any future transitions of like-vendors.
• Provide leadership and oversight for all clinical government program implementations
• Provide strategic leadership for the integration of CMS Interoperability mandates into clinical operations, ensuring compliance with federal requirements such as the CMS Interoperability and Patient Access Final Rule, while aligning with organizational goals.
• Drive cross-functional collaboration between clinical, IT, compliance, and other stakeholder teams to implement interoperability solutions that enhance prior authorization workflows, streamline data exchange, and improve member and provider experience.
• Monitor evolving regulations, accreditation standard, mandates, and industry standards to proactively guide UM policy development, technology investments, and operational readiness, ensuring the organization innovation and compliance.

REQUIRED QUALIFICATIONS

• 7 years of clinical experience
• 5 years of management experience
• 5 years of managed care, health services, health outcomes, or disease management experience, specifically in developing and implementing clinical programs
• 5 years of experience in developing short- and long-range strategic plans, forecasting, and budgeting

• Bachelor of Arts or Bachelor of Science degree in a healthcare-related field

• Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a registered nurse (RN).

• N/A

PREFERRED QUALIFICATIONS

• 10 years of management experience
• 10 years of clinical experience in a primary care field
• 10 years of managed care, health services, health outcomes, or disease management experience, specifically in developing and implementing clinical programs
• 5 years of experience in developing short- and long-range strategic plans, forecasting, and budgeting

• Master’s degree in healthcare administration, business administration or related field

• N/A

• N/A

ESSENTIAL job functions AND RESPONSIBILITIES

• Assume accountability for current in-house management and offshore delegated arrangements, including implementation of all Commercial and Medicare components, training and auditing, monitoring producti