Manager, Maternal Health (Hybrid)

Manager, Maternal Health (Hybrid) Phoenix, AZ Job Details Full-time 1 day ago Benefits Health insurance Qualifications Collaborate with healthcare professionals Community engagement Nursing Strategic management Mental health and behavioral care Clinical program implementation Insurance prior authorization Operations management Presentation software Electronic health records (EHR) management RN License Achieving HIPAA compliance Program development Maintaining patient confidentiality Regulatory compliance Local agency collaboration Family planning Master's degree in nursing State healthcare regulations Performance management 3 years Master's degree High school diploma or GED Team development Preventive health (patient care) CMS regulatory compliance Clinical staff training Supervising experience Bachelor's degree Team management InterQual Case management Utilization management Master of Nursing Quality improvement Centers for Medicare and Medicaid Services (CMS) Mentoring Women's health and reproductive patient care Clinical documentation Organizational skills Accredited Case Manager Nursing Case Management Certification Healthcare team management Medical License Networking through strategic partnership building Bachelor's degree in nursing CRRN Certified Case Manager Employee engagement Senior level Strategic partnerships Microsoft Project Care coordination Leadership Communication skills Staffing management Certified Disability Management Specialist Training delivery Physician Assistant License Staff development

COHN CRC

Full Job Description 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 Manager of Maternal Health provides strategic, operational, and clinical leadership for maternal health programs serving the Medicaid population. This role is accountable for ensuring member access to timely prenatal and postpartum care; promoting family planning and preventive services; improving quality outcomes; and ensuring effective coordination of care across providers, community partners, and internal teams.

QUALIFICATIONS REQUIRED QUALIFICATIONS

Required Work Experience 5 years of experience in clinical care 5 years of experience with the maternal health population 3 years of prior supervisory and/or management experience Required Education High School Diploma or GED in general field of study Required Licenses Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN), physician or physician's assistant Required Certifications Once they have directly supervised the integrated care process within (3) years with the organization, hold a certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)

PREFERRED QUALIFICATIONS

Preferred Work Experience Care management experience Health plan experience Behavioral health experience Program development experience Knowledge of NCQA and/or URAC health plan standards, AHCCCS, and CMS regulatory requirements Preferred Education Bachelor's or master's degree in nursing or healthcare related field. Preferred Licenses N/A Preferred Certifications

N/A ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Provide strategic, operational, and clinical leadership for maternal health programs serving the Medicaid population. Lead the day-to-day operations of the maternal health team, including staffing, coaching, performance management, and professional development. Foster a positive, collaborative, and inclusive team environment that promotes engagement, accountability, and high performance. Oversee maternal health program operations, including: Identification and outreach to pregnant members Pre-authorization of maternity services Care management for high-risk pregnant and postpartum members Transition-of-care support following delivery Newborn verification and coordination of services Ensure timely access to prenatal, postpartum, family planning, and preventive services through effective care coordination. Collaborate with providers, hospitals, community organizations, and internal teams to address the clinical and health‑related social needs of pregnant and postpartum members. Partner with provider organizations to develop and support value‑based care arrangements and effective care coordination processes that improve maternal health outcomes. Build and maintain strong provider and community partnerships to support maternal and infant health outcomes. Set quantitative and qualitative goals for the maternal health program and measure program performance. Monitor program performance, utilization, and outcomes; implement improvements to enhance quality and efficiency. Ensure compliance with all applicable regulatory and accreditation requirements, including NCQA, URAC, AHCCCS, CMS, and other state and federal regulations. Provide training, guidance, and technical assistance to staff and providers to support regulatory compliance, program effectiveness, and best practices in maternal health care. Write and submit required program documentation and reports, including an annual maternity and family planning program description and evaluation. Represent the organization professionally in interactions with internal stakeholders, providers, regulators, and community partners. Ensure the confidentiality of member information and compliance with HIPAA and organizational privacy policies. The position has an onsite expectation of 2 days 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

COMPETENCIES REQUIRED COMPETENCIES

Required Job Skills MS Office, PowerPoint, MS Project, EHR, case management software. Possesses strong clinical background in maternity care with a focus on the delivery of high quality and cost-effective care. Experience working with multiple provider types along the continuum of care, such as physician groups, hospitals, home health agencies, and skilled nursing facilities. Demonstrates ability to problem solve and coach staff when necessary. Previous management experience. Self-motivated and assertive. Demonstrated supervisory and management skills; ability to mentor and lead a staff team. Ability to collaborate with providers and administrators to achieve quality and cost-effective care. Excellent written and verbal communication skills; ability to interact with individuals at all levels within an organization. Requisite poise, judgment, and trustworthiness to represent the Blue Cross Blue Shield of Arizona to internal and external groups. Maintains information in a confidential manner according to policy. Required Professional Competencies N/A Required Leadership Experience and Competencies

N/A PREFERRED COMPETENCIES

Preferred Job Skills Thorough understanding of health plan and regulatory rules and policies, including NCQA and URAC; understanding of utilization management criteria (e.g. InterQual); understanding of provider delegated relationships with health plans. Thorough understanding of managed care, care management, and referral/authorization operations and principles. Recent patient care management experience, as well as excellent leadership, team building, and communication skills. Preferred Professional Competencies N/A Preferred Leadership Experience and Competencies N/A 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.