Integrated Care Manager – Adult

🕒 6 dias atrás

🌵 Arizona – Remoto

🌵 Arizona – Remote

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

👔 Gerente

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Blue Cross Blue Shield of Arizona

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1939

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

A Blue Cross Blue Shield of Arizona é uma fornecedora de seguros de saúde que oferece uma variedade de planos de saúde adaptados para indivíduos, famílias, empregadores e beneficiários do Medicare. Com um compromisso de melhorar o acesso à saúde e o bem-estar da comunidade, a AZ Blue fornece planos de saúde auto-segurados e compatíveis com a ACA, incluindo opções de Medicare Advantage e Medicaid. A organização foca em conectar os membros ao cuidado através de sua extensa rede, visando melhores resultados de saúde e apoio à comunidade.

Descrição

• 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 • Ensure care meets individual healthcare needs while promoting quality and cost-effective outcomes • Focus primarily on case management and assist with utilization management if needed • 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 when applicable • Monitor and report team progress • Communicate issues and improvement opportunities • Mentor and support team members • Work a minimum of 40 hours per week; additional hours may be required based on business needs • Perform other duties as assigned

🎯 Requisitos

• 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 • Conflict resolution • Ability to represent the organization in the community

🏖️ Benefícios

• Hybrid workforce strategy called Workability, offering flexibility with how and where employees work • Remote work opportunity with no regular onsite requirements • Continuing education in healthcare, behavioral health, and managed care annually