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Clinical Accreditation Program Consultant
Blue Cross Blue Shield of ArizonaClinical Accreditation Program Consultant working with UM/Care Management at Blue Cross Blue Shield of Arizona. Supporting regulatory requirements and managing compliance with accreditation and Medicare.
About the role
Key responsibilities & impact- Responsible for supporting the UM/Care Management Department by providing professional oversight with an emphasis on regulatory requirements and those processes related to State, Federal, BCBSAZ, Accreditation and Medicare.
- Lead and coordinate or participate in the processes of initial delegation and ongoing oversight of delegated entities.
- Assist in various aspects of accreditation, delegation, and CMS activities.
- Develop and document health improvement/management programs for members in compliance with applicable state, federal, accreditation and Medicare regulations.
- Support business processes and data flows and how they affect health management/BCBS processes, systems and other operational areas.
Requirements
What you’ll need- 1 year of experience in clinical and health insurance or other healthcare related field (Level 1)
- 2 years of experience in clinical and health insurance or other healthcare related field + 1 year of managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management, Medical Appeals and Grievance (MAG), Quality Management and/or Accreditation and Medicare requirements (Level 2)
- 3 years of experience in clinical and health insurance or other healthcare related field + 2 years of managed care experience (Level 3)
- Associate degree in Nursing or Post High School Nursing Diploma
- Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse
Benefits
Comp & perks- Health insurance
- Flexible work arrangements
- Professional development opportunities
- Paid time off
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical experiencehealth insurance experiencemanaged care experienceUtilization Management (UM)Prior Authorization (PA)Claims ManagementCase ManagementMedical AppealsGrievance ManagementQuality Management
Certifications
Registered Nurse license