Integrated Care Manager - Remote/Hybrid Opportunity with Blue Cross Blue Shield of Arizona

Join a Culture of Innovation and Teamwork at Blue Cross Blue Shield of Arizona

At Blue Cross Blue Shield of Arizona (AZ Blue), we're committed to inspiring health and making it easy for individuals, families, and businesses to achieve their wellness goals. As a recognized Healthiest Employer, we're dedicated to fostering a dynamic work environment that encourages collaboration, innovation, and growth. We're now seeking an experienced and skilled Integrated Care Manager to join our team in a remote/hybrid capacity within the state of Arizona.

About Us

AZ Blue offers a range of health insurance products and services designed to meet the diverse needs of our members. Our mission is built on a foundation of providing information and tools that empower individuals to make informed decisions about their health. As a leader in the health insurance industry, we're passionate about delivering exceptional care and support to our members.

Job Summary

As an Integrated Care Manager, you will play a critical role in promoting continuity of care for our members through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services. This role requires a strong and diverse skillset in relevant areas, including case management, utilization management, and customer service. If you're a motivated and compassionate professional looking for a challenging and rewarding opportunity, we encourage you to apply.

Key Responsibilities

• Assess and collect data related to members from various care settings, and interview and collaborate with case-related providers, members, and families to implement care plans.
• Respond to a diverse and high-volume of health insurance-related customer calls on a daily basis, providing clear and concise information about our services, benefits, and programs.
• 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 management and medical directors, and consult and coordinate with internal departments, external plans, providers, businesses, and government agencies to resolve customer inquiries.
• Meet quality, quantity, and timeliness standards to achieve individual and department performance goals, and maintain complete and accurate records per department policy.
• Demonstrate ability to apply plan policies and procedures effectively, and participate in continuing education and current development in the field of medicine, behavioral health, and managed care.
• Collaborate with team members to distribute workload and tasks, monitor and report team tasks, and communicate team issues and opportunities for improvement to management.

Qualifications and Requirements

Essential Qualifications

• 2 years of 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 of study (e.g., MSW, MA, MS, M.Ed.), Ph.D., or Psy.D.
• Active, current, and unrestricted license to practice in Arizona as a behavioral health professional (LCSW, LPC, LISAC, LMFT, or licensed psychologist) or an active, current, and unrestricted license to practice nursing in Arizona or a state recognized by the Nursing Licensure Compact (NLC) as an RN.
• Certification in case management within 3 years of hire (CCM, CMAC, CMC, CRC, CRRC, COHN, RN, C, or RN, BC).
• Intermediate PC proficiency and intermediate skill in use of office equipment, including copiers, fax machines, scanner, and telephones.
• Intermediate skill in word processing, spreadsheet, and database software.

Preferred Qualifications

• 3 years of experience in direct clinical care to consumers.
• 1-2 years 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 (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN, C, or RN, BC).
• Advanced PC proficiency and knowledge of CPT 2018 and ICD-10 coding.
• Knowledge of managed care, utilization management, and quality management, as well as working knowledge of McKesson InterQual, MCG, ASAM, or other nationally recognized criteria.

Skills and Competencies

Required Skills and Competencies

• Maintain confidentiality and privacy.
• Advanced and current clinical knowledge.
• Practice interpersonal and active listening skills to achieve customer satisfaction.
• Interpret and translate policies, procedures, programs, and guidelines.
• Capable of investigative and analytical research.
• Demonstrated organizational skills with the ability to prioritize tasks and work with multiple priorities.
• Follow and accept instruction and direction.
• Establish and maintain working relationships in a collaborative team environment.
• Apply independent and sound judgment with good problem-solving skills.
• Navigate, gather, input, and maintain data records in multiple system applications.

Preferred Skills and Competencies

• Knowledge of health and/or patient education and behavior change techniques.

Career Growth and Development

At AZ Blue, we're committed to supporting the growth and development of our employees. As an Integrated Care Manager, you'll have opportunities to expand your skills and expertise in case management, utilization management, and customer service. You'll also have access to ongoing training and education to stay up-to-date on industry trends and best practices.

Work Environment and Culture

We're a dynamic and inclusive organization that values diversity, equity, and inclusion. Our remote/hybrid work environment offers flexibility and work-life balance, while our collaborative team culture encourages innovation and teamwork. We're proud to be a recognized Healthiest Employer, and we're committed to supporting the well-being of our employees.

Compensation and Benefits

We offer a competitive salary and benefits package that includes a range of perks and rewards. While specific details are not disclosed, our compensation package is designed to reflect the value we place on our employees and their contributions to our organization.

Conclusion

If you're a dedicated and compassionate professional looking for a challenging and rewarding opportunity, we encourage you to apply for this Integrated Care Manager role at Blue Cross Blue Shield of Arizona. Join our team and be part of a culture that inspires health and makes it easy for our members to achieve their wellness goals. Apply now and take the first step towards a fulfilling career with AZ Blue!

AZ Blue is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other protected group.