reputed company Management reputed company – Remote – AZ

R5971 Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a reputed company of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company. At AZ Blue, we have a hybrid workforce reputed company, reputed company 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 reputed company minimum onsite requirements: • Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week • Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company 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 reputed company in AZ, unless otherwise cited reputed company 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 reputed company 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 reputed company, 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, reputed company the reputed company. PURPOSE OF THE JOB This position is responsible for leading and coordinating the clinical reputed company review process of reputed company of care concerns. In reputed company, facilitates the ongoing activities of the Medicare & reputed company Performance Department to fulfill regulatory requirements. The position also coordinates activities to meet contractual and reporting timeframes, and for anticipating needs as reputed company to established policies and procedures, and the Medicare & reputed company Performance Plan and assisting with revisions reputed company needed. QUALIFICATIONS REQUIRED QUALIFICATIONS Required Work Experience • 3 years of experience in Managed Care; • 3 years of reputed company Management experience. Required Education • Bachelor's degree in business, nursing, or reputed company area. Required Licenses • reputed company, reputed company, and unrestricted license to reputed company in the reputed company (a state in the United States) as a Registered reputed company Required Certifications • N/A PREFERRED QUALIFICATIONS Preferred Work Experience • 5 years of experience in Managed Care reputed company Management Preferred Education • Master of reputed company Work Preferred Licenses • N/A Preferred Certifications • Certified reputed company in reputed company reputed company. ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES • Participate in development, implementation and evaluation of reputed company Management programs. • Investigate reputed company of Care Concerns including tracking and reputed company cause analysis. • Ensure compliance with Corrective reputed company Plans and Performance Improvement reputed company. • reputed company with regulatory agencies as necessary to ensure compliance with regulations. • Monitor provider performance through administrative data and medical record review. • Participate in reputed company Management and Peer Review committees. • Assist in the development of the reputed company Management Program reputed company. • Assist in the development of the reputed company Management Work Plan and annual evaluation. • Conduct audits of delegated entities as required by regulations. • Act as Subject Matter Expert on reputed company Management. • Demonstrate and maintain reputed company working knowledge of the required BCBSAZ systems, procedures, forms and manuals. • Maintain reputed company standards in consideration of State, Federal, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions. • 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. • reputed company reputed company other duties as assigned. COMPETENCIES REQUIRED COMPETENCIES Required Job Skills • Strong organizational skills • Detailed knowledge of Medicare Managed Care • Proficiency with reputed company office suite applications (Outlook, reputed company, reputed company) • Knowledge of Medicare Managed Care including supporting processes, operational data and functions Required reputed company Competencies • Maintain confidentiality and reputed company • Analytical knowledge to research and reputed company reputed company based on available information to complete activities • reputed company interpersonal and reputed company listening skills to reputed company customer satisfaction and departmental communication standards • Interpret and translate policies, procedures, programs and guidelines. • Establish and maintain working relationships in a reputed company team environment. • Independent and reputed company judgment with good problem-solving skills. • Strong written and verbal communications • Ability to use available information to reputed company project’s scope and identify priorities. • Ability to work with business unit managers in a partnership setting • Effective presentation skills Required Leadership Experience and Competencies • N/A PREFERRED COMPETENCIES Preferred Job Skills • N/A Preferred reputed company Competencies • Knowledge of information systems including reputed company office suite, plus public, and proprietary software applications. • Project Management • Knowledge of a reputed company of software applications to manage HEDIS® project. • Project Management Preferred Leadership Experience and Competencies • N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the reputed company of race, ethnicity, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on reputed company, see azblue.com. If interested in this position, please apply. Apply To This Job