About Prosano Health Solutions: Prosano Health Solutions, in partnership with Blue Cross Blue Shield of Arizona, has launched an Advanced Primary Care model with a clear mission: To Inspire Health and Make it Easy . Our goal is to deliver affordable, convenient, and personalized care to the communities we serve. Our Advanced Primary Care model is focused on providing a signature patient experience which will raise the bar in both the delivery of care, and by ensuring health equity is top of mind. And, in every market we serve, we assure that a customized, high-value system of care is available for our members . Together, we will set the standard for how healthcare can and should be delivered in our State. Why Join Our Team? Here’s the fun part. We are growing our team. The team will include people who share our passion and deep commitment to taking the primary care experience to a new level. Our team is unified in providing not only comprehensive care, but a truly exceptional patient experience, leaving our patients with the lasting impression of trust and compassion. We realize we can do great things by working together and adapting processes to provide the best possible care for people. Together, we will improve the health within our communities and make a difference in people’s lives. If you share this vision and desire to do something different...we look forward to talking to you! For more information, please reach out to our Talent Acquisition team. This position is Onsite within the state of AZ only. This Onsite work opportunity requires residency, and work to be performed, within the State of Arizona. About Prosano Health Solutions: Prosano Health Solutions, in partnership with Blue Cross Blue Shield of Arizona, is launching an Advanced Primary Care model with a clear mission: To Inspire Health and Make it Easy . Our goal is to deliver affordable, convenient, and personalized care to the communities we serve. Our Advanced Primary Care model is focused on providing a signature patient experience which will raise the bar in both the delivery of care, and by ensuring health equity is top of mind. In every market we serve, our goal is to bring to the community a customized, high-value system of care that is available for our members. Together, we will set the standard for how healthcare can and should be delivered in our State. Why Join Our Team? Here’s the fun part. We are in the phase where we are building our team. The team will include people who share our passion and deep commitment to taking the primary care experience to a new level. Our team is unified in providing not only comprehensive care, but a truly exceptional patient experience, leaving our patients with the lasting impression of trust and compassion. We realize we can do great things by working together and adapting processes to provide the best possible care for people. Together, we will improve the health within our communities and make a difference in people’s lives. If you share this vision and desire to do something different, we look forward to talking to you! For more information, please reach out to our Talent Acquisition team. Our Benefits: Up to 18 days PTO, 11 paid holidays 8 hours paid Volunteer hours to serve our community! Medical, Dental and Vision Coverage 401(k) up to 5% dollar per dollar match Tuition Reimbursement Employee discounts, gym reimbursement, wellness programs and more! Performance Incentive Plan You Will: The Clinical Care Guide (RN) will be a key contributor to our first-class care team at Prosano Health Solutions. They will deliver on our commitment to excellence to our patients and help us grow through their role. The Clinical Care Guide will have end to end responsibility for our specialist and diagnostic testing navigation, as well as in leading and partnering with the care team in supporting patients in their journey toward their best health. This position has an emphasis on customer/patient care excellence, privacy, compliance, and serving in a dynamic health setting. Support members both in-person and virtually with real-time consultation, education, scheduling of specialist & diagnostic referral appointments, and follow-through + follow-up of those appointments Play a critical role in the achievement of improved health outcomes and cost savings Be an empathetic problem-solver and become the most visible partner to all patients Clarify and explain referral for specialist and diagnostic service recommendations Care for end to end process as needed, for referral or specialist services Lead center in development and management of quality programs to include patient outreach to members in an effort to provide an elevated primary care experience with gaps in care or other clinical needs Support members with chronic conditions by providing education, reminders, and other support Handle the management and integration of office processes Lead service and schedule requests on member’s behalf Inform and equip Care Team with referral information and requirements Be an ambassador in the local community - building relationships with other healthcare providers, social/community organizations, and marketing partners Perform all other duties as assigned You Have: Excellent interpersonal skills to include maintaining courteous, friendly and effective communications with patients, team members and external parties Current active unrestricted state license to practice as a Registered Nurse BLS certification within 30 days of hire Electronic Medicare Records experience Customer service orientation and experience Strong communication skills across multiple modalities Highly collaborative Empathy and advocacy Exceptional organizing skills, detail-orientation Must be able to maintain confidentiality at all times Fingerprint clearance to be obtained within 30 days of hire Immunization records or documentation of immunity for all required immunizations must be provided prior to hire or placement in the role. Employees who have not received immunizations for COVID or an annual flu vaccine and have provided documentation of an exception for medical or religious reasons will be required to wear a properly fitting mask while in any Prosano Clinic or as required by management. Preferred Qualifications: Bachelor's degree in Nursing (BSN) Case Management Certification (CCM) Proficiency with other health care related software platforms High degree of independence, flexibility, initiative and commitment Our Commitment and Vision: Prosano Health Solutions 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. Our Commitment Prosano Health Solutions 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 Prosano Health Solutions. If interested in this position, please apply.
About Prosano Health Solutions: Prosano Health Solutions, in partnership with Blue Cross Blue Shield of Arizona, has launched an Advanced Primary Care model with a clear mission: To Inspire Health and Make it Easy . Our goal is to deliver affordable, convenient, and personalized care to the communities we serve. Our Advanced Primary Care model is focused on providing a signature patient experience which will raise the bar in both the delivery of care, and by ensuring health equity is top of mind. And, in every market we serve, we assure that a customized, high-value system of care is available for our members . Together, we will set the standard for how healthcare can and should be delivered in our State. Why Join Our Team? Here’s the fun part. We are growing our team. The team will include people who share our passion and deep commitment to taking the primary care experience to a new level. Our team is unified in providing not only comprehensive care, but a truly exceptional patient experience, leaving our patients with the lasting impression of trust and compassion. We realize we can do great things by working together and adapting processes to provide the best possible care for people. Together, we will improve the health within our communities and make a difference in people’s lives. If you share this vision and desire to do something different...we look forward to talking to you! For more information, please reach out to our Talent Acquisition team. This position is onsite within the state of AZ only. This onsite work opportunity requires residency, and work to be performed, within the State of Arizona. You Will: The Nurse Practitioner or Physician Assistant will be a key contributor to our first-class clinical team in the assessment of healthcare needs and effectiveness of care outcomes. They will deliver our commitment of excellence to our patients and help us grow through their participation in continuous improvement and innovative population health activities. This position has an emphasis on customer/patient care excellence, privacy, compliance, and serving in a dynamic health setting. Evaluate and treat patients in accordance with standards of care. Direct coordination of patient services, including but not limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care Act as an active participant and lead as needed within the care team structure in daily huddles Partner with Care Team in the ongoing operations of a healthy culture Complete all medical record documentation in a timely manner Follow policy and protocol defined by Clinical Leadership Meet with Collaborative Physician and/or Care Team leaders at pre-determined intervals to discuss quality of care, review of outcome data, policy &procedure updates, and documentation issues Participate in potential growth opportunities for new or existing services within the Center Assure personal compliance with licensing, certification, and accrediting bodies Be an ambassador in the local community - building relationships with other healthcare providers, social/community organizations, and marketing partners Perform all other duties as assigned Working hours may include extended hours This position requires 100% on-site work at the care center location and may also involve movement between clinics as needed You Have: Minimum of two to five years directly applicable experience preferred Successful completion of a Nurse Practitioner or Physician Assistant program with Board Certification Active, unrestricted Nurse Practitioner or Physician Assistant license in the state of Arizona Excellent communication skills; written and verbal, demonstrate a high level of skill with interpersonal relationships and communications with all colleagues; fully engaged in the concept of “Integrated team based care”. Willingness and ability to learn/adapt to practice in a value-based care setting. Superior patient/customer service. Basic computer skills, including email and EMR. Appropriate certification to write prescriptions under the authority of a collaborating physician/medical director BLS certification Active AZ fingerprint clearance card Active Drug Enforcement Administration (DEA) license. Our Commitment Prosano Health Solutions 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 Prosano Health Solutions. If interested in this position, please apply.
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.
