Integrated Care Manager – prior Health Plan CM experience

🔥 12 hours ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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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 assessment, planning, implementation, coordination, monitoring, and evaluation of care options and services • Assess and collect member data from all care settings • Interview and collaborate with providers, members, and families to implement care plans • Answer a diverse and high volume of health-insurance-related customer calls • Explain contract benefits, coverage changes, eligibility, claims, BCBSAZ programs, and provider networks • Analyze medical records and apply medical necessity criteria and benefit plan requirements • Present case status reports to managers/supervisors and medical directors when indicated • Coordinate with internal departments, external plans, providers, businesses, and government agencies to resolve inquiries • Meet quality, quantity, timeliness, and department performance standards • Maintain compliance with state, federal, BCBSAZ, URAC, and other accreditation requirements • Maintain complete and accurate records • Apply plan policies and procedures effectively • Collaborate on team workload distribution and task monitoring when needed • Communicate team issues and improvement opportunities to supervisors/managers • Support and mentor team members when indicated • Participate in annual continuing education and professional development • Perform other assigned duties

🎯 Requirements

• 2 years of full-time equivalent direct clinical care experience with consumers • Associate’s Degree in a general field of study, Post High School Nursing Diploma, or Master’s Degree in a behavioral health field; Ph.D. or Psy.D. • Active, current, and unrestricted Arizona behavioral health professional license, or an active, current, and unrestricted nursing license in Arizona or another U.S. state recognized by the Nursing Licensure Compact (NLC) • Within 4 years of hire, must hold a case management certification such as CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN,C, or RN,BC • Intermediate PC proficiency • Intermediate proficiency with office equipment including copiers, fax machines, scanners, and telephones • Intermediate proficiency in word processing, spreadsheet, and database software • Maintain confidentiality and privacy • Advanced and current clinical knowledge • Interpersonal and active listening skills • Ability to interpret and translate policies, procedures, programs, and guidelines • Investigative and analytical research skills • Organizational skills and ability to prioritize multiple tasks • Ability to follow instructions and direction • Ability to establish and maintain collaborative working relationships • Independent judgment and problem-solving skills • Ability to navigate, gather, input, and maintain data records in multiple applications • Conflict resolution skills • Ability to represent BCBSAZ in the community • Preferred: 3 years of direct clinical care experience • Preferred: 1–2 years of experience working in a managed care organization • Preferred: Bachelor’s Degree in Nursing or a Health and Human Services-related field • Preferred: active and current case management certification • Preferred: advanced PC proficiency • Preferred: knowledge of CPT 2018 and ICD-10 coding • Preferred: knowledge of managed care, utilization management, and quality management • Preferred: working knowledge of McKesson InterQual, MCG, ASAM, or other nationally recognized criteria • Preferred: knowledge of organizational services and operations • Preferred: knowledge of health/patient education and behavior change techniques

🏖️ Benefits

• Hybrid workforce strategy (Workability) offering flexibility with how and where employees work • Remote work opportunity for Arizona residents without regular onsite requirements • Full-time employment schedule of at least 40 hours per week • Continuing education and current development in medicine, behavioral health, and managed care • Training, staff meetings, one-on-ones, and team-building opportunities as applicable • Equal opportunity and nondiscrimination in hiring and employment