Blue Cross Blue Shield of Arizona
Rare Condition Manager - Remote AZ
Blue Cross Blue Shield of Arizona, Phoenix, Arizona, United States, 85003
Join to apply for the Rare Condition Manager - Remote AZ role at Blue Cross Blue Shield of Arizona.
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.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Most employees should expect onsite requirements and at a minimum of once per week.
This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
Purpose of the Job To support high-quality, cost-effective care by coordinating services for members through comprehensive case management, with a specialized focus on individuals with rare or complex conditions. This role ensures continuity of care by assessing needs, developing care plans, facilitating access to appropriate resources, and collaborating with providers to achieve optimal health outcomes.
Required Qualifications
Work Experience:
2 years of experience in full-time equivalent of direct clinical care to the consumer
Education:
Associate’s Degree in general field of study or Post High School Nursing Diploma
Licenses:
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as 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.
Preferred Qualifications
Preferred Work Experience: 3 years of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)
1-2 years of experience working in a managed care organization
Preferred Education: Bachelor's Degree in Nursing or Health and Human Services related field of study
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).
Essential Job Functions and Responsibilities
Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan.
Make and answer a diverse and high volume of condition management-related member calls on a daily basis.
Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs.
Analyze medical records, claims data, and other information sources.
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, BCBSAZ programs, provider networks, etc.
Present status reports on 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.
Required Job 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
Required Professional 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
Demonstrated 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
Required Leadership Experience and Competencies
Conflict Resolution
Represent BCBSAZ 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
Working knowledge of McKesson InterQual, MCG, ASAM, or other nationally recognized criteria
Knowledge of a wide range of matters pertaining to the organizations services and operations
Knowledge of health and/or patient education and behavior change techniques
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.
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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.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Most employees should expect onsite requirements and at a minimum of once per week.
This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
Purpose of the Job To support high-quality, cost-effective care by coordinating services for members through comprehensive case management, with a specialized focus on individuals with rare or complex conditions. This role ensures continuity of care by assessing needs, developing care plans, facilitating access to appropriate resources, and collaborating with providers to achieve optimal health outcomes.
Required Qualifications
Work Experience:
2 years of experience in full-time equivalent of direct clinical care to the consumer
Education:
Associate’s Degree in general field of study or Post High School Nursing Diploma
Licenses:
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as 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.
Preferred Qualifications
Preferred Work Experience: 3 years of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)
1-2 years of experience working in a managed care organization
Preferred Education: Bachelor's Degree in Nursing or Health and Human Services related field of study
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).
Essential Job Functions and Responsibilities
Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan.
Make and answer a diverse and high volume of condition management-related member calls on a daily basis.
Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs.
Analyze medical records, claims data, and other information sources.
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, BCBSAZ programs, provider networks, etc.
Present status reports on 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.
Required Job 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
Required Professional 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
Demonstrated 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
Required Leadership Experience and Competencies
Conflict Resolution
Represent BCBSAZ 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
Working knowledge of McKesson InterQual, MCG, ASAM, or other nationally recognized criteria
Knowledge of a wide range of matters pertaining to the organizations services and operations
Knowledge of health and/or patient education and behavior change techniques
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.
#J-18808-Ljbffr