Integrated Care Manager - Medicare Advantage (prior CM experience working in a health plan)- Remote

About the role

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Responsibilities

• 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 that meet the individuals' health care needs while promoting quality, cost effective outcomes.
• Primary for case management functions but can assist with utilization management if a business need arises.

Requirements

• Required Work Experience: 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
• Required Education: 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
• Required Licenses: 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.
• Required Certifications: 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).

Qualifications

• Preferred Work Experience: 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)
• Preferred Education: Bachelor's Degree in Nursing or Health and Human Services related field of study
• Preferred Licenses: N/A
• Preferred Certifications: 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).

Skills

• Intermediate PC proficiency
• Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
• Intermediate skill in word processing, spreadsheet, and database software

Competencies

• Maintain confidentiality and privacy
• Advanced and current clinical knowledge
• Practice interpersonal and active listening skills to achieve customer satisfaction
• Interpret and translate policies, procedures, programs, and guidelines
• Capable of investigative and analytical research
• Demonstrate organizational skills with the ability to prioritize tasks and work with multiple priorities
• Follow and accept instruction and direction
• Establish and maintain working relationships in a collaborative team environment
• Apply independent and sound judgment with good problem solving skills
• Navigate, gather, input, and maintain data records in multiple system applications

Leadership Experience and Competencies

• Conflict Resolution
• Represent BCBSAZ in the community

Our Commitment

Blue Cross Blue Shield of Arizona 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.