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 remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
The Clinical Project Lead is responsible for leading established clinical initiatives, including the development, implementation, and evaluation of clinical practice guidelines, member education materials, and provider resources in collaboration with the Director of Care Management. This role works collaboratively across departments to promote evidence-based care, member engagement, and health equity.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
- 3 years of experience in nursing, public health, clinical research, healthcare project management, or guideline development
- 2 years of experience in care coordination
Required Education
- Bachelor’s degree or higher in a relevant field such as nursing, public health, pharmacy, life sciences (biology or chemistry), a behavioral health field of study, or healthcare administration
Required Licenses
Required Certifications
PREFERRED QUALIFICATIONS
Preferred Work Experience
- 5 years of experience in nursing, clinical research, healthcare project management, or guideline development
Preferred Education
Preferred 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
Preferred Certifications
- Project Management Professional (PMP), Six Sigma/Lean Project Management, Certified Care Manager (CCM), or related certification
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Identify and maintain current evidence-based clinical practice guidelines for the Medicaid segment, in collaboration with internal and external stakeholders
- Develop and update member education materials and self-management tools, ensuring that the selected materials meet the needs of the member population
- Evaluate and implement certified decision-making aids for the provider network
- Ensure materials are culturally appropriate, accessible, and aligned with health literacy standards
- Ensure that all guidelines and materials are reviewed, approved, and updated regularly, according to regulatory requirements
- Communicate clinical and educational content to providers, staff, and members via multiple channels, including health plan websites, newsletters, and social media
- Lead and coordinate the Member Education Materials Workgroup
- Actively participate in health plan committees, presenting materials for review when needed
- Develop processes to integrate the materials into care management workflows, coordinating across departments to create and optimize technology solutions
- Provide staff training regarding clinical practice guidelines, member education materials, and other topics as assigned
- Evaluate the effectiveness of selected materials in supporting member health outcomes
- Contribute to deliverables and annual plan documents, including writing sections related to assigned projects
- Support the development of the annual population assessment
- Coordinate care for justice-involved members, supporting transitions of care, reentry planning, and community resource linkage
- Maintain complete and accurate records per department policy
- Independently create, implement, and execute project plans
- Plan, direct, and manage projects and associated activities to ensure goals and objectives are accomplished within prescribed time frames and funding parameters
- Monitor, coordinate, and communicate the strategic objectives of projects across the organization to optimize outcomes
- Collaborate in the aggregation and analysis of internal and external data
- Contribute to strategic organizational initiatives, including regulatory surveys and contract bids
- Ensure compliance with all regulatory requirements, including NCQA, URAC, AHCCCS, CMS, state and federal regulations
- Perform all other duties as assigned
- Occasional travel and after-hours participation in committee meetings may be required
REQUIRED COMPETENCIES
Required Job Skills
- Knowledge of clinical guidelines and evidence-based practices
- Experience with care coordination and community-based services
- Demonstrated ability to develop and lead de novo projects
- Proficiency in project management
- Ability to think analytically to resolve issues, apply a solution-focused mindset
- Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
- Computer literate with MS Office, databases, project management software
- Ability to learn new applications
Required Professional Competencies
- Proven history of successful results in managing projects, meeting deadlines, and advancing new program start-ups
- Excellent communication, collaboration, and writing skills
Required Leadership Experience and Competencies
PREFERRED COMPETENCIES
Preferred Job Skills
- Successful, proven track-record with large-scale organizational change efforts
- Advanced knowledge of healthcare system
Preferred Professional Competencies
- Familiarity with project management approaches, tools, and phases of project lifecycle
- Solid understanding of the change process and how people respond to change
Preferred Leadership Experience and Competencies
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Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.