New

ADOA Nurse - Hybrid

Blue Cross Blue Shield of Arizona
United States, Arizona, Phoenix
Nov 05, 2025
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa 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 Serve as a dedicated health resource for ADOA employees, supporting individuals in meeting their health care needs while promoting quality, cost-effective outcomes. The Onsite Nurse will work closely with vendors, wellness teams, and AZ Blue and ADOA stakeholders to improve employee health outcomes, promote benefit utilization, and support mental and physical well-being. QUALIFICATIONS REQUIRED QUALIFICATIONS Required Work Experience 3 years of clinical nursing experience Experience in care coordination, case management or employee health Required Education Associate's Degree in general field of study or Post High School Nursing Diploma 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) or Practice Nurse (LPN). Required Certifications N/A PREFERRED QUALIFICATIONS Preferred Work Experience 5 years in health advocacy, case management, disease management wellness, or benefits navigation 1-2 years experience working in a managed care organization Preferred Education Bachelor's Degree in Nursing or related field Preferred Licenses N/A Preferred Certifications Case Management or Health Coaching Certification ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Leverage AZ Blue services and vendor advocacy programs to support employee health and promote utilization of health benefits. Facilitate employee health engagement and navigation, including referrals to quality providers and coordination with wellness, care management, and health management teams. Partner with the High-Cost Containment Unit to review high-dollar medical and pharmacy claims to assess member engagement and medication adherence and direct to appropriate resources or services. Conduct or facilitate medication adherence reviews in collaboration with pharmacy partners (e.g., Samia) Assist with redirection of care for repeat ER users. Coordinate with appropriate internal stakeholders to help employees find in-network providers and schedule appointments. Coordinate with appropriate internal stakeholders to support post-discharge needs and continuity of care. Coordinate with appropriate internal stakeholders to monitor high-cost medications and treatments for adherence and effectiveness. Provide resources and referrals for mental health support including coordination with the ADOA Employee Assistance Program (EAP). Generate performance reports and share insights with leadership. Attend and support onsite wellness events and expos. Participate in ADOA virtual and in-person meetings, health fairs, and Directors' meetings as needed. Maintain documentation and ensure compliance with HIPAA and organizational policies. Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other applicable accreditation requirements. Collaborate with the Sales team to develop strategy and tactics for population health Develop, implement and market education programs to ADOA employees, including delivery of educational trainings on various health topics Establish and maintain a positive working relationship to ensure a high level of client satisfaction Provide population health reporting for health management program operations Participate in continuing education and current development in the field of medicine, disease self-management, social drivers of health, behavioral health and managed care. Volunteer within the community to help BCBSAZ give back. The position has an onsite expectation of 1 day 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. Perform all other duties as assigned. COMPETENCIES REQUIRED COMPETENCIES Required Job Skills Familiarity with systems, procedures, forms and manuals required by position Working knowledge of a wide range of matters pertaining to the AZ Blue's services and operations. Intermediate skill in use of office equipment including copier, fax machine, scanner and telephones Ability to interpret policies and contracts. Knowledge of BCBSAZ operations sufficient to determine which department and/ or person to contact to resolve an inquiry Ability to adapt to new software applications and a frequently changing workflow environment Maximum organizational skills to meet productivity goals Strong clinical judgment and care coordination skills Familiarity with health benefits, pharmacy programs, and provider networks Proficiency in Microsoft Office and health data systems Ability to interpret medical and pharmacy claims data Required Professional Competencies Always presents a professional image when dealing with the ADOA Maintain a professional relationship when dealing with other departments Maintain confidentiality and privacy Effectively apply new concepts and techniques; ingenuity to anticipate and meet unexpected situations Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data Capable of investigative and analytical research Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards Establish and maintain working relationships in a collaborative team environment Effective written and verbal communication, as well as excellent oral presentation skills. Required Leadership Experience and Competencies Ability to influence health outcomes through education and advocacy Use data to identify priorities and guide employee engagement PREFERRED COMPETENCIES Preferred Job Skills Bilingual Spanish / English 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.