Mgr-Care Management (Hybrid)

About the position 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.

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

Requirements

• 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
• High School Diploma or GED in general field of study
• 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
• 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)
• 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.

Nice-to-haves

• 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
• Bachelor's or master's degree in nursing or healthcare related field.
• 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.

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