Healthcare Ventures & Innovation Coordinator (RN), Phoenix, AZ
Job Title Healthcare Ventures & Innovation Coordinator (Registered Nurse)
Job ID 4756
Full/Part Time Full-Time
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,400 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.
- Incorporate transformation of practices into high performance of HEDIS, STAR quality performance, HCC and ACO type of metrics. Experience in performance improvement of practices with impact on value based care reimbursement models.
- Responsible for assisting the Enterprise Medical Director of Healthcare Ventures and Innovation in creating a contemporary delivery model that provides a wide array of value based payment models through new provider partnerships and enhancements of existing relationships. Works with business partners internally and externally to develop and monitor metrics of success, and create solutions and remove barriers to ensure business goals are met. Ensures that operations are implemented with regards to developing new programs and changes to existing programs in Healthcare Ventures & Innovations area.
- Advise, document, track and at times execute work plans for all programs, related to Healthcare Ventures & Innovation, inclusive of both internal and external deliverables.
- Support the Enterprise Medical Director in the development and evolution of value based growth strategies and integrate potential strategic partnerships as requested.
- Create a culture of accountability throughout the healthcare delivery system by bringing actionable data to the point of care delivery, which drives improved clinical outcomes through evidence-based medicine.
- Design, develop, implement and grow our value based programs with PCMH, ACOP, Narrow Networks and other corporate initiatives to improve patient outcomes, improve quality, and reduce inappropriate medical spend. Create cultural environment with members and employees supportive of these initiatives.
- Manage requirements, strategic projects, reports, analysis, and deadlines, and coaches on implementation requirements.
- Work with partners across the organization to build team relationships aligned with internal and external expectations of Healthcare Quality Assurance and Provider Network
- Lead implementation of new PCMH and VBP programs including review of clinical content, deployment of operational components and reporting on the status of implementation.
- Benchmark medical services policies, procedures and activities relative to local and national markets.
- Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.
- Establish direction, support and medical expertise to the Network division, including utilization management targets, quality management targets, and medical claims analysis as it relates to Value based payments.
- Identify and implement opportunities for collaboration with vendors to improve the program outcomes.
- The position 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.
- Perform all other duties as assigned.
Required Work Experience
- 5 years of experience in healthcare operations
- 5 years of management experience, including major project development
- 5 years of experience in provider performance improvement or value based care programs
- Bachelor’s Degree in Nursing
- Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN).
Required Professional Certifications
Preferred Work Experience
- 5 years of experience in healthcare quality including HEDIS & STARS
- 5 years of experience in HCC & RAF
- 5 years of experience in healthcare medical management
- 2 years of experience working on or with Agile teams
- Master’s degree in business, healthcare administration, or related field
BCBSAZ 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.