Manager, Integrated Care - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Hybrid

About The Position

Blue Cross Blue Shield of Arizona (AZ Blue) is hiring a Manager, Integrated Care to develop and manage day-to-day processes for Care Management, including utilization management and case management. The manager will primarily focus on either utilization management or case management. The role promotes quality, cost-effective outcomes and compliance with regulatory requirements while supporting an integrated, whole-person continuum of care for members with complex and chronic health care needs. This hybrid position is limited to Arizona residents, with an onsite expectation of two days per week. The role requires a full-time schedule of at least 40 hours per week, plus additional hours as requested or needed to meet business requirements. The manager oversees staff and programs, supports accreditation and performance monitoring, coordinates with internal and external partners, and contributes to staff development and organizational improvements.

Requirements

At least 2 years of full-time-equivalent direct clinical care experience with consumers.
At least 1 year of supervisory experience.
Associate’s degree in a general field of study or post-high-school nursing diploma; alternatively, a master’s degree in a behavioral health field, Ph.D., or Psy.D.
An active, current, unrestricted Arizona license or endorsement to practice as a behavioral health professional (such as LCSW, LPC, LISAC, LMFT, or licensed psychologist), or an active, current, unrestricted RN license from Arizona or another U.S. state recognized by the Nursing Licensure Compact.
Within three years of directly supervising the integrated care process at the organization, obtain a case management certification from the listed certifications: CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN,C, or RN,BC.
Intermediate skill using office equipment, including copier, fax machine, scanner, and telephones.
Intermediate PC proficiency and intermediate skill with word processing, spreadsheet, and database software.
Maintain confidentiality and privacy in accordance with State, Federal, BCBSAZ, and accreditation requirements.
Advanced and current clinical knowledge and understanding of the medical management process.
Analytical skills to generate reports from available data and make decisions based on reported data; investigative and analytical research capability.
Interpersonal and active-listening skills to achieve customer satisfaction.
Ability to compose business correspondence and interpret and translate policies, procedures, programs, and guidelines.
Ability to navigate, gather, input, and maintain data records in multiple system applications.
Ability to establish and maintain collaborative working relationships across BCBSAZ departments and divisions.
Organizational skills, ability to prioritize and manage multiple priorities, independent judgment, and problem-solving skills.
Ability to use employees’ skills and abilities to deliver business objectives, focus team activities using available information, identify priorities, and build a high-performing team culture.
Arizona residency and ability to perform work within Arizona; onsite attendance is required two days per week.
Ability to work at least 40 hours per week, with additional hours as requested or needed to meet business requirements.

Nice To Haves

At least 5 years of full-time-equivalent direct clinical care experience or experience in the health insurance field.
At least 2 years of supervisory experience.
At least 2 years of experience working in a managed care organization.
Bachelor’s or master’s degree in Nursing or a Health and Human Services-related field, or a doctoral degree in a behavioral health-related field.
Active, current case management certification in one of the following: CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN,C, or RN,BC.
Advanced PC proficiency.
Current knowledge of State, Federal, BCBSAZ, and other applicable regulatory and accrediting agency requirements as they apply to department functions.
Working knowledge of McKesson InterQual, Milliman Care Guidelines, ASAM, or other nationally recognized medical necessity criteria.
Effective presentation and leadership skills.

Responsibilities

Manage and oversee staff activities related to developing and delivering health improvement and management programs for members with complex and chronic health care needs.
Promote an integrated, whole-person approach to a continuum of care.
Provide oversight and recommendations on cases managed through the programs.
Direct activities required to maintain Case Management and Utilization Management accreditation.
Monitor and report department and program performance measures, including IRR, and recommend operational improvements based on results.
Evaluate, interpret, and negotiate applicable benefit and regulatory requirements.
Identify, research, process, resolve, and respond to customer inquiries and correspondence by telephone, written communication, or in person.
Review and maintain the accuracy of documentation, computer files, policies, and procedures related to departmental goals and objectives, and recommend operational improvements.
Consult and coordinate with internal departments, external plans, providers, businesses, and government agencies to obtain information and implement operational changes and process improvements.
Keep the unit current on service standards, systems, procedures, forms, and manuals through staff meetings and verbal and written communication.
Provide current case management and pertinent clinical resources.
Facilitate staff training, continuing education, and development by identifying needs, developing curriculum, and delivering or coordinating training, including clinical decision-making and critical thinking related to member care.
Communicate updates regarding organizational goals and changes to staff.
Conduct formal performance evaluations in accordance with BCBSAZ corporate policy, including reviewing and assessing Care Management staff documentation.
Obtain feedback on support staff performance from care managers who receive their direct support and interact with them regularly.
Interview, evaluate, and make recommendations regarding employment decisions.
Participate at least annually in continuing education and keep current with developments in medicine, behavioral health, social determinants, and managed care.
Perform other duties as assigned.