Mgr. Pediatric Clinical Programs

About the position The position at Blue Cross Blue Shield of Arizona is focused on developing and managing the day-to-day processes required for Integrated Clinical Management activities. The primary goal is to promote quality and cost-effective outcomes while ensuring compliance with all regulatory requirements. This role involves significant responsibilities in research, development, and improvement of prevention programs and strategies throughout the network. The individual will be tasked with developing collaborative partnerships with community and provider agencies, clinicians, and community members to identify necessary resources. Additionally, the position requires providing training and technical assistance to staff and providers, preparing reports, and monitoring providers for compliance with NCQA, state, and federal regulations. Conducting annual needs and capacity assessments is also a critical component of this role. The position is hybrid, requiring work and residency within the state of Arizona. The successful candidate will need to demonstrate strong leadership and management skills, particularly in a clinical setting, and will be expected to maintain confidentiality and privacy in accordance with State, Federal, and BCBSAZ accreditation requirements. The role demands advanced clinical knowledge and the ability to analyze data effectively to generate reports and make informed decisions. Strong interpersonal skills and the ability to work collaboratively within a team environment are essential for success in this position. Responsibilities • Develop and manage day-to-day processes for Integrated Clinical Management activities. , • Promote quality and cost-effective outcomes while ensuring compliance with regulatory requirements. , • Research, develop, and improve prevention programs and strategies throughout the network. , • Develop collaborative partnerships with community and provider agencies, clinicians, and community members. , • Provide training and technical assistance to staff and providers. , • Prepare reports and monitor providers for compliance with NCQA, state, and federal regulations. , • Conduct annual needs and capacity assessments. Requirements • 3 years' experience in clinical care. , • 2-3 years' experience in a supervisory role. , • Bachelor's Degree in Nursing or a master's degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.). , • Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN) or independent license in the behavioral health profession such as LCSW, LPC, LISAC, LMFT. , • Certification in case management after directly supervising the integrated care process within 3 years with the organization. Nice-to-haves • 5 years' experience in 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 experience. , • Knowledge of population health concepts and models. , • Knowledge of NCQA Standards. , • Master's Degree in Nursing.

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