This position is responsible for: the development, implementation, measurement and oversight of selected health education programs and wellness initiatives, working collaboratively with internal staff and regional medical directors, and external providers, employers and community resources in the following ways: Developing initiatives which pro-actively impact the long term outcomes of cost and utilization, basing the interventions on nationally recognized guidelines; Evaluating programs utilizing nationally recognized outcomes measures: and developing revised and new intervention action plans based on those evaluations and customer satisfaction input. Also provides clinical insight to Medical Management issues and contributes to and supports the Enterprise Medical Management Plan.
Nature & Scope
This position will plan, coordinate, facilitate and implement health education programs and wellness initiatives for Arkansas Blue Cross Blue Shield, its subsidiaries, provider affiliates, employers, and network providers. To accomplish this, the incumbent will require a sound clinical experience with a base in disease process, knowledge of the ABCBS & affiliates organization, provider community and community resources and an understanding of coverage policy as it relates to member contracts in all lines of business. The incumbent will be responsible for organizing or assisting in organizing work groups made up of internal staff, network providers and the regional community in order to effectively develop, implement health education program initiatives. This individual will have budget accountability. This individual must be able to represent the division upon request.
The position reports to and is directly accountable to the Manager, Health Improvement, and works in cooperation with the Director of Enterprise Medical Management.
Minimum Job Requirements
1. Registered Nurse, licensed and in good standing in the state of Arkansas required.
2. Clinical experience required.
3. Experience developing and planning Health Education Programs required.
4. Health insurance experience preferred.
5. Bachelor's degree desired.
6. Skills using Outlook, Word, Excel and Web-based health information search desired.
7. Knowledge of ABCBS, HMO and USAble systems and organization and Clinical Care Advance CM/DM system desired.
This position is identified as level three (3). This position must ensure the security
and confidentiality of records and information to prevent substantial harm, embarrassment,
inconvenience, or unfairness to any individual on whom information is maintained.
The integrity of information must be maintained as outlined in the company Administrative
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented
or detected on a timely basis by employees in the normal course of business. This
position must adhere to the segregation of duties guidelines in the Administrative
PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
1. Plan, organize, direct and control those functions that relate to Health Education Programs and other health improvement projects as assigned.
2. Define, implement and manage administrative objectives, policies and procedural guidelines through sound utilization of existing facilities and resources.
3. Assist in the development and adherence to the operating budget for the Health Improvement section of EMM division.
4. Provide cost effective utilization of resources for clinical and preventive health initiatives.
5. Serve as departmental liaison with practitioners, employers, other health organizations, and providers in relation to the assigned Health Education Program projects or Enterprise Medical Management Program and Policy projects.
6. Promote and maintain credibility, competence and a positive organizational image by exhibiting a strong communication with internal and external customers.
7. Provide leadership in the development of new Health Education Programs.
8. Establish formal and informal mechanisms to assure positive communications and relations with all employees and providers of the Enterprise.
9. Delegate projects and responsibilities to team members as appropriate.
10. Ensure adequate and timely reporting of the status of all active and scheduled initiatives. 11. Review and evaluate team performance for meeting target dates, completion of tasks, and accuracy. (Supervision of Health Education Assistant and Enterprise Medical Management Support Specialist.)
12. Assume other assignments as necessary.
Arkansas Blue Cross and Blue Shield - 20 months ago
In 2012, Arkansas Blue Cross was named one of central Arkansas’ “Top Work Places” by the Arkansas Democrat-Gazette and...