Integrated Care Manager – Adult

🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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Blue Cross Blue Shield of Arizona

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Blue Cross Blue Shield of Arizona is a health insurance provider offering a variety of health plans tailored to individuals, families, employers, and Medicare recipients. With a commitment to improving healthcare access and community health, AZ Blue provides self-insured and ACA-compliant health plans, including Medicare Advantage and Medicaid options. The organization focuses on connecting members with care through its extensive network, aiming for better health outcomes and community support.

📋 Description

• Promote continuity of care through a collaborative process of assessing, planning, implementing, coordinating, monitoring, and evaluating care options and services • Ensure care meets individual healthcare needs while promoting quality and cost-effective outcomes • Focus primarily on case management and assist with utilization management when 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, monitor and report team progress, communicate issues and improvement opportunities, and mentor team members when applicable • Perform other duties as assigned

🎯 Requirements

• 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, Ph.D., or Psy.D. • Active, current, unrestricted Arizona behavioral health professional license such as LCSW, LPC, LISAC, LMFT, or licensed psychologist, or active, current, unrestricted RN license in Arizona or a Nurse Licensure Compact state • Must obtain an approved case management certification within 4 years of hire: CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, or RN-BC • Intermediate PC skills • Intermediate use of office equipment including copiers, fax, scanners, and 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 skills • Ability to represent the organization in the community • Full-time availability of at least 40 hours per week; additional hours may be required based on business needs

🏖️ Benefits

• Remote work opportunity with no regular onsite requirements • Flexible Workability workforce strategy • Continuing education in healthcare, behavioral health, and managed care annually