Supervisor, Pediatric Clinical Programs

Job Description

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

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 The Supervisor, Pediatric Clinical Programs leads a staff comprising of clinical and nonclinical members.

The position is focused on ensuring the Care Management department achieves required service standards by measuring team performance against goals / metrics, directing the flow of work, and identifying opportunities for process improvements while meeting the goals of the population health model.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

• Minimum : 5 years of combined pediatric experience in nursing, behavioral healthcare, or health plan care management
• 1-2 years prior supervisory experience managing pediatric clinical and non-clinical teams
• 2 years’ experience in direct pediatric clinical care

2. Required Education

Bachelor’s Degree in Nursing

3. 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)

4. Required Certifications

Once they have directly supervised the integrated care process within 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

1. Preferred Work Experience

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

2. Preferred Education · Masters in Nursing

3. Preferred Licenses

N / A

REQUIRED COMPETENCIES

1. Required Job Skills

• Intermediate skill in use of office equipment including copier, fax machine, scanner, and telephones
• Intermediate PC proficiency
• Intermediate skill in word processing, spreadsheet, and database software
• Excellent communication, collaboration, and delegation skills.
• Proficiency in project management
• Ability to think analytically to resolve issues; solution-focused mindset; creative and innovative
• Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
• Ability to learn new applications
• Data analytics skills

2. Required Professional Competencies

• Maintain confidentiality and privacy in consideration of State, Federal, BCBSAZ and other accreditation requirements
• Advanced and current clinical knowledge
• Demonstrates knowledge and understanding of the medical management process
• Analytical knowledge necessary to generate reports based on available data and the ability to make decisions based on reported data
• Capable of investigative and analytical research
• Practice interpersonal and active listening skills to achieve customer satisfaction
• Compose a variety of business correspondence
• Interpret and translate policies, procedures, programs, and guidelines
• Navigate, gather, input, and maintain data records in multiple system applications
• Establish and maintain working relationships in a collaborative team environment with all BCBSAZ Departments / Divisions
• Organizational skills with the ability to prioritize tasks and work with multiple priorities
• Independent and sound judgment with good problem-solving skills

3. Required Leadership Experience and Competencies

• Make use of employee's skills and abilities to deliver business objectives
• Use available information to focus on the team's activities and identify priorities
• Ability to develop and build a high-performing team culture

PREFERRED COMPETENCIES

1. Preferred Job Skills Advanced PC proficiency

2. Preferred Professional Competencies

Maintains current knowledge of State, Federal, BCBSAZ, and other applicable regulatory / accrediting agency requirements as they apply to department functions

3. Preferred Leadership Experience and Competencies

• Demonstrates practical presentation skills
• Demonstrated practical leadership skills

4. Preferred Leadership Experience and Competencies

• Demonstrated practical leadership skills
• Demonstrates practical presentation skills
30+ days ago