Health Manager, Respiratory Therapist - Remote AZ

Blue Cross Blue Shield • Phoenix, AZ

231d • Onsite

About The Position

Responsible for supporting members in achieving self-efficacy in managing their health condition(s) through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates self-management strategies and care services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes.

Requirements

• 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer.
• Associate's Degree in general field of study or Post High School Nursing Diploma.
• Active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, or active registration as a Registered Dietician (RD) or Registered Dietitian Nutritionist (RDN), or active registration as a Respiratory Therapist/Respiratory Care Practitioner.
• Within 4 years of hire, hold a certification in case management from one of the following: Certified Case Manager (CCM), Case Management Administrator Certified (CMAC), Case Management Certified (CMC), Registered Nurse Case Manager, or other approved related certification.

Nice To Haves

• 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer.
• 1-2 year(s) of experience working in a managed care organization.
• Experience working with individuals living with chronic conditions such as: Diabetes, CHF, COPD, CAD, CKD, and asthma.
• Bachelor's Degree in Nursing or Health and Human Services-related field of study.
• Diabetes Care and Education Specialist (DCES) (formerly Certified Diabetes Educator (CDE)).
• Certified Lifestyle Medicine Professional.
• Certified Health Coach.
• Case Management Certification.

Responsibilities

• Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan.
• Conduct member-centered planning, including shared goal-setting and member-tailored education and interventions to support the member in achieving self-efficacy for condition management.
• Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs.
• Recommend and refer services and resources to members based on their individualized needs, specific health plan, and community and cultural preferences.
• Make and answer a diverse and high volume of condition management-related member calls on a daily basis.
• Explain to members a variety of information concerning the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
• Analyze medical records, claims data, and other information sources.
• Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
• Consult and coordinate with other Health Managers, various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of member inquiries.
• Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other applicable accreditation requirements.
• Maintain complete and accurate records per department policy.
• Demonstrate ability to apply plan policies and procedures effectively.
• Collaborate with team to distribute workload/work tasks; Monitor and report team tasks; Communicate team issues and opportunities for improvement to supervisor/manager; Support/mentor team members.
• Participate in continuing education and current development in the field of medicine, disease self-management, social drivers of health, behavioral health and managed care.
• Represent BCBSAZ and the Health Management Program at member events up to 5% of the time.
• Volunteer within the community to help BCBSAZ give back.
• Perform all other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree