PURPOSE OF THE JOB
The Clinical Project Lead is responsible for leading established clinical initiatives, including the development, implementation, and evaluation of clinical practice guidelines, member education materials, and provider resources in collaboration with the Director of Care Management. This role works collaboratively across departments to promote evidence-based care, member engagement, and health equity. This role also supports efforts to improve access and outcomes for justice-involved individuals, helping bridge gaps in care during transitions and reentry.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
- 3 years of experience in nursing, public health, clinical research, healthcare project management, or guideline development
- 2 years of experience in care coordination
Required Education
- Bachelor’s degree or higher in a relevant field such as nursing, public health, pharmacy, life sciences (biology or chemistry), a behavioral health field of study, or healthcare administration
Required Licenses
Required Certifications
PREFERRED QUALIFICATIONS
Preferred Work Experience
- 5 years of experience in nursing, clinical research, healthcare project management, or guideline development
Preferred Education
Preferred 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 independent license in the behavioral health profession such as LCSW, LPC, LISAC LMFT
Preferred Certifications
- Project Management Professional (PMP), Six Sigma/Lean Project Management, Certified Care Manager (CCM), or related certification
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Identify and maintain current evidence-based clinical practice guidelines for the Medicaid segment, in collaboration with internal and external stakeholders
- Develop and update member education materials and self-management tools, ensuring that the selected materials meet the needs of the member population
- Evaluate and implement certified decision-making aids for the provider network
- Ensure materials are culturally appropriate, accessible, and aligned with health literacy standards
- Ensure that all guidelines and materials are reviewed, approved, and updated regularly, according to regulatory requirements
- Communicate clinical and educational content to providers, staff, and members via multiple channels, including health plan websites, newsletters, and social media
- Lead and coordinate the Member Education Materials Workgroup
- Actively participate in health plan committees, presenting materials for review when needed
- Develop processes to integrate the materials into care management workflows, coordinating across departments to create and optimize technology solutions
- Provide staff training regarding clinical practice guidelines, member education materials, and other topics as assigned
- Evaluate the effectiveness of selected materials in supporting member health outcomes
- Contribute to deliverables and annual plan documents, including writing sections related to assigned projects
- Support the development of the annual population assessment
- Coordinate care for justice-involved members, supporting transitions of care, reentry planning, and community resource linkage
- Maintain complete and accurate records per department policy
- Independently create, implement, and execute project plans
- Plan, direct, and manage projects and associated activities to ensure goals and objectives are accomplished within prescribed time frames and funding parameters
- Monitor, coordinate, and communicate the strategic objectives of projects across the organization to optimize outcomes
- Collaborate in the aggregation and analysis of internal and external data
- Contribute to strategic organizational initiatives, including regulatory surveys and contract bids
- Ensure compliance with all regulatory requirements, including NCQA, URAC, AHCCCS, CMS, state and federal regulations
- Perform all other duties as assigned
- Occasional travel and after-hours participation in committee meetings may be required
- 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.
REQUIRED COMPETENCIES
Required Job Skills
- Knowledge of clinical guidelines and evidence-based practices
- Experience with care coordination and community-based services
- Demonstrated ability to develop and lead de novo projects
- Proficiency in project management
- Ability to think analytically to resolve issues, apply a solution-focused mindset
- Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
- Computer literate with MS Office, databases, project management software
- Ability to learn new applications
Required Professional Competencies
- Proven history of successful results in managing projects, meeting deadlines, and advancing new program start-ups
- Excellent communication, collaboration, and writing skills
Required Leadership Experience and Competencies
PREFERRED COMPETENCIES
Preferred Job Skills
- Successful, proven track-record with large-scale organizational change efforts
- Advanced knowledge of healthcare system
Preferred Professional Competencies
- Familiarity with project management approaches, tools, and phases of project lifecycle
- Solid understanding of the change process and how people respond to change
Preferred Leadership Experience and Competencies
#LI-AB1
