Clinical Project Lead - 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 position is hybrid within the state of AZ only. This hybrid 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. This role also supports efforts to improve access and outcomes for justice-involved individuals, helping bridge gaps in care during transitions and reentry.

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

N/A

Required Certifications

N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

5 years of experience in nursing, clinical research, healthcare project management, or guideline development

Preferred Education

N/A

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
• •The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

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

N/A

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

N/A

#LI-AB1

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.