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Blue Cross Blue Shield of Arizona · 1 day ago

Integrated Care Manager - Adult (Remote in AZ)

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

Blue Cross Blue Shield of Arizona is dedicated to inspiring health and providing insurance products and services. The Integrated Care Manager is responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options for members.

Financial ServicesHealth CareHealth InsuranceInsurance

Responsibilities

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan

Answer a diverse and high volume of health insurance related customer calls on a daily basis

Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc

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 the manager/supervisor and, when indicated, to the medical director

Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries

Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines

Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements

Maintain complete and accurate records per department policy

Demonstrate ability to apply plan policies and procedures effectively

When indicated to assist with team/project functions: Collaborate with team to distribute workload/work tasks; Monitor and report team tasks; Communicate team issues and opportunities for improvement to supervisor/manager; Support/mentor team members

Participate in continuing education and current development in the field of medicine, behavioral health and managed care at least annually

The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

Perform all other duties as assigned

Qualification

Behavioral health licenseCase management certificationDirect clinical care experienceNursing licenseManaged care experiencePC proficiencyInterpersonal skillsOrganizational skillsProblem solving skillsConflict resolutionActive listening

Required

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer

Associate's Degree in general field of study ***or*** Post High School Nursing Diploma or Master's Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D

Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN

Within 4 years of hire as a Care Manager employee must hold a *certification* in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)

Preferred

3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)

1-2 year (s) 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 from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)