Integrated Care Manager- Adult - Remote-AZ

PURPOSE OF THE JOB

Responsible for promoting 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. Ensures care meets individual healthcare needs while promoting quality and cost-effective outcomes. This role is primarily focused on case management but may assist with utilization management if needed.

QUALIFICATIONS

• Required Work Experience: 2 years of full-time equivalent experience in direct clinical care to consumers
• Required Education: 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
• Required Licenses: 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
• Required Certifications: 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

PREferred QUALIFICATIONS

• Preferred Work Experience: 3 years of direct clinical care experience (managed care case management preferred)
• Preferred Education: Bachelor’s Degree in Nursing or Health and Human Services
• Preferred Licenses: None
• Preferred Certifications: Active case management certification (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, RN-BC)

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• 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
• Maintain compliance with state, federal, and accreditation requirements
• Ensure accurate and complete documentation
• Apply policies and procedures effectively
• Team Support (when applicable): Assist in workload distribution, Monitor and report team progress, Communicate issues and improvement opportunities, Mentor and support team members, Participate in continuing education in healthcare, behavioral health, and managed care annually

WORK SCHEDULE

Full-time role (minimum 40 hours per week) Additional hours may be required based on business needs

COMPETENCIES

• Required Job Skills: Intermediate PC skills, Intermediate use of office equipment (copiers, fax, scanners, phones), Intermediate skills in word processing, spreadsheets, and databases
• Required Professional Competencies: 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
• Required Leadership Competencies: Conflict resolution, Ability to represent the organization in the community
• Preferred Job Skills: Advanced PC proficiency, Knowledge of CPT 2018 and ICD-10 coding
• Preferred Professional Competencies: Knowledge of managed care, utilization management, and quality management, Familiarity with InterQual, MCG, ASAM, or similar criteria tools, Understanding of organizational services and operations, Knowledge of patient education and behavior change techniques
• Preferred Leadership Competencies: None

OUR COMMITMENT

AZ Blue 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. Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.