Mgr. Pediatric Clinical Programs (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 once per week

• Hybrid Individual Contributors: 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 month.

This is a hybrid position that requires work and residency within the state of Arizona.

Purpose of the job

Responsible for developing and managing the day to day processes required to provide Integrated Clinical Management activities that promote quality, cost effective outcomes and remain compliant with all regulatory requirements.

Additionally responsible for research, development, and improvement of prevention programs and strategies throughout the network. Responsibilities include developing collaborative partnerships with community and provider agencies, clinicians, and community members to identify resources; providing training and technical assistance to staff and providers; preparing reports; and monitoring providers for compliance with NCQA, state, and federal regulations. Conducts annual needs and capacity assessments.

REQUIRED QUALIFICATIONS

Required Work Experience

• 3 years’ experience in clinical care

• 2 -3 years’ experience in a supervisory role

Required Education

• Bachelor’s Degree in Nursing or master’s degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.)

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) or independent license in the behavioral health profession such as LCSW, LPC, LISAC LMFT

Required Certifications

• Once they have directly supervised the integrated care process within (3) years with the organization, hold a certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).
   

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 5 years’ experience in full-time equivalent of direct clinical care to youth and adolescents
• Physical and behavioral health experience
• 3-4 years’ experience in a supervisory role
• 2-3 years of experience working in a managed care organization
• Program development
• Knowledge of population health concepts and models
• Knowledge of NCQA Standards

Preferred Education

• Master’s Degree in Nursing

Preferred Licenses

• N/A

Preferred Certifications

Active and current certification in case management from the following certifications: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN-BC).

REQUIRED COMPETENCIES

Required Job Skills

• Intermediate skill in use of office equipment including copier, fax machine, scanner, and telephones
• Intermediate PC proficiency