Integrated Care Manager - Adult (Remote)

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Remote

About The Position

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona (AZ Blue) aims to inspire health and make it easy. AZ Blue provides a variety of health insurance products and services to meet the diverse needs of individuals, families, and businesses, offering information and tools for better health decisions. The company employs a hybrid workforce strategy called Workability, which offers flexibility in how and where employees work, classifying positions as hybrid, onsite, or remote. This specific role is remote, requiring residency and work to be performed within the State of Arizona, though leadership may request onsite presence for business reasons. The purpose of this job is to promote 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. The goal is to meet individual health care needs while promoting quality, cost-effective outcomes. While primarily focused on case management functions, the role may also assist with utilization management if business needs arise.

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 or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an 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.
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).

Nice To Haves

3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)
1-2 year (s) of experience working in a managed care organization
Bachelor's Degree in Nursing or Health and Human Services related field of study
Active and current certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).

Responsibilities

Assess and collect data related to the member from all care settings.
Interview and collaborate with case-related providers, member and family to implement the care plan.
Answer a diverse and high volume of health insurance related customer calls on a daily basis.
Explain to customers 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 and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer 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 accreditation requirements.
Maintain complete and accurate records per department policy.
Demonstrate ability to apply plan policies and procedures effectively.
When indicated to assist with team/project functions: 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, behavioral health and managed care at least annually.
The position 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.