Integrated Care Manager- Adult - Remote-AZ

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Remote

About The Position

Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members through their benefit plan. Ensures care meets individual healthcare needs while promoting quality and cost-effective outcomes. This role is primarily focused on case management but may assist with utilization management if needed.

Requirements

2 years of full-time equivalent experience in direct clinical care to consumers
Associate’s Degree in a general field of study OR Post High School Nursing Diploma OR Master’s Degree in a behavioral health field (MSW, MA, MS, M.Ed.), Ph.D., or Psy.D
Active, current, unrestricted license in Arizona (or eligible via endorsement) as a behavioral health professional such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.) OR Active, current, unrestricted RN license in Arizona or a Nurse Licensure Compact (NLC) state
Within 4 years of hire, must obtain one of the following case management certifications: CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, or RN-BC
Intermediate PC skills
Intermediate use of office equipment (copiers, fax, scanners, phones)
Intermediate skills in word processing, spreadsheets, and databases
Maintain confidentiality and privacy
Advanced clinical knowledge
Strong interpersonal and active listening skills
Ability to interpret and explain policies and procedures
Strong analytical and research skills
Organizational skills with ability to manage multiple priorities
Ability to follow direction
Team collaboration skills
Sound judgment and problem-solving ability
Ability to manage and maintain data across multiple systems

Nice To Haves

3 years of direct clinical care experience (managed care case management preferred)
1–2 years of experience in a managed care organization
Bachelor’s Degree in Nursing or Health and Human Services
Active case management certification (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, RN-BC)
Advanced PC proficiency
Knowledge of CPT 2018 and ICD-10 coding
Knowledge of managed care, utilization management, and quality management
Familiarity with InterQual, MCG, ASAM, or similar criteria tools
Understanding of organizational services and operations
Knowledge of patient education and behavior change techniques
Conflict resolution
Ability to represent the organization in the community

Responsibilities

Assess and collect member data from all care settings
Collaborate with providers, members, and families to implement care plans
Handle high-volume health insurance-related customer calls daily
Explain benefits, coverage, eligibility, claims, programs, and networks
Review medical records and determine medical necessity based on criteria and benefits
Present case status updates to leadership and medical director as needed
Coordinate with internal departments, providers, and external agencies
Meet quality, productivity, and timeliness standards
Maintain compliance with state, federal, and accreditation requirements
Ensure accurate and complete documentation
Apply policies and procedures effectively
Assist in workload distribution
Monitor and report team progress
Communicate issues and improvement opportunities
Mentor and support team members
Participate in continuing education in healthcare, behavioral health, and managed care annually
Perform other duties as assigned