Director, Integrated Care Management - 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.

This role is classified as a People Leader. Please see our in-office requirements for People Leaders within the job posting.

Purpose of the job

• Responsible for overseeing the Integrated Care Management department to ensure operations in compliance with clinical guidelines, contractual, accreditation, and regulatory requirements for all business segments.

REQUIRED QUALIFICATIONS

Required Work Experience

• 10 years of experience in a clinical field of practice, health insurance, or other healthcare setting/field
• 5 or more years leading a team of at least five clinical professionals in a clinical or managed care setting
• 5 years relevant case management and/or condition management experience and current clinical knowledge
• Experience in developing and executing operational strategies that result in improved member outcomes, increased service levels, and clinical efficiencies

Required Education

• Bachelor’s degree in nursing, healthcare administration, public health, social work or health related field

Required Licenses

• Active, current and unrestricted license to practice in Arizona as a health professional

Required Certifications

• Within 3 years of hire, hold a certification in case management from one of the following: Certified Case Manager (CCM), Case Management Administrator Certified (CMAC), Case Management Certified (CMC), Registered Nurse Case Manager, or other approved related certification

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 7 years or more leading a department of 10 or more staff in a clinical or managed care setting
• 5 years experience in data collection, analysis and reporting

Preferred Education

• Master’s degree in healthcare administration, public health, nursing, social work or other health related field

Preferred Licenses

• Active, current and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN.

Preferred Certifications

• Case Management Certification

ESSENTIAL job functions AND RESPONSIBILITIES

• Manage and oversee all staff activities related to the development and delivery of the Integrated Condition Management department across all business segments to ensure program interventions, goals and targeted outcomes are integrated with systems/processes and in alignment with strategic initiatives.
• Lead the Integrated Care Management department strategic planning activities under the direction of clinical leadership and contribute to the achievement of BCBSAZ’s Make Arizona Healthier goals.
• Promote integrated, whole-person, member-centric approaches to care management.
• Maintain all standards in consideration of st