Clinical Project Lead (RN) - Remote AZ

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   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  REQUIRED COMPETENCIES  Required Job Skills  Knowledge of clinical guidelines and evidence-based practices  Experience with care coordination and community-based services