Clinical Project Lead - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

6d•Hybrid

About The Position

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.

Requirements

3 years of experience in nursing, public health, healthcare project management, or guideline development
2 years of experience in care coordination
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
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
Proven history of successful results in managing projects, meeting deadlines, and advancing new program start-ups
Excellent communication, collaboration, and writing skills
Residency within the State of Arizona

Nice To Haves

5 years of experience in nursing, clinical research, healthcare project management, or guideline development
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
Project Management Professional (PMP), Six Sigma/Lean Project Management, Certified Care Manager (CCM), or related certification
Successful, proven track-record with large-scale organizational change efforts
Advanced knowledge of healthcare system
Familiarity with project management approaches, tools, and phases of project lifecycle
Solid understanding of the change process and how people respond to change

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