Manager, Integrated Care - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

2d•Hybrid

About The Position

The Manager, Integrated Care is responsible for developing and managing day-to-day processes for Care Management, including utilization management and case management activities. These activities are intended to promote quality, cost-effective outcomes and comply with regulatory requirements. The manager will serve primarily in either utilization management or case management. The position oversees staff delivering health improvement and management programs for members with complex and chronic health care needs, supports an integrated whole-person continuum of care, and monitors program performance, accreditation, documentation, and operational practices. It also coordinates with internal departments and external organizations, supports staff development, and participates in continuing education and developments in medicine, behavioral health, social determinants, and managed care. This is a full-time hybrid position in Arizona. The role requires residency and work to be performed within Arizona, with onsite work expected two days per week. Full-time is defined as at least 40 hours per week, plus additional hours as requested or needed to meet business requirements.

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 work in Arizona) as a behavioral health professional, such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.); alternatively, an active, current, unrestricted RN license in 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, hold 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 in word processing, spreadsheet, and database software.
Maintain confidentiality and privacy in accordance with applicable state, federal, BCBSAZ, and accreditation requirements.
Advanced and current clinical knowledge and knowledge of the medical management process.
Analytical ability to generate reports from available data and make decisions based on reported data; investigative and analytical research skills.
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 and sound judgment, and problem-solving skills.
Leadership 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.

Nice To Haves

At least 5 years of full-time-equivalent direct clinical care experience with consumers 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 certification in case management: 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 relevant to department functions.
Working knowledge of McKesson InterQual, Milliman Care Guidelines, ASAM, or other nationally recognized medical necessity criteria.
Effective presentation skills.
Effective 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 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, update, and ensure 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 unit status current in accordance with service standards, systems, procedures, forms, and manuals through staff meetings and verbal and written communications.
Provide current case management and pertinent clinical resources.
Facilitate staff training, continuing education, and development, including identifying needs, developing curriculum, and delivering or coordinating training in clinical decision-making and critical thinking related to member care.
Ensure organizational goals and changes are communicated to staff.
Conduct formal job performance evaluations in accordance with corporate policy, including reviewing and assessing Care Management staff documentation.
Obtain feedback on support staff performance from care managers who receive direct support from and regularly interact with them.
Interview, evaluate, and make recommendations regarding employment decisions.
Participate at least annually in continuing education and developments in medicine, behavioral health, social determinants, and managed care.
Perform other duties as assigned.