Blue Cross Blue Shield of Arizona
Integrated Care Manager (FEP) (Remote-AZ)
Blue Cross Blue Shield of Arizona, Phoenix, Arizona, United States, 85003
Integrated Care Manager (FEP) (Remote-AZ)
Blue Cross Blue Shield of Arizona is hiring a remote Integrated Care Manager for the state of Arizona. This role focuses on promoting continuity of care through a collaborative process that evaluates and coordinates member health services.
This position is fully remote within Arizona and requires the candidate to reside in the state. The hybrid workforce strategy allows flexibility, but remote employees are not subject to onsite requirements unless specifically requested for business purposes.
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. This job description is primary for case management functions but can assist with utilization management if a business need arises.
Required Qualifications
2 years of full‑time equivalent direct clinical care experience to the consumer.
Associate’s Degree in a general field or Post‑High School Nursing Diploma, Master’s in behavioral health (MSW, MA, MS, M.Ed.), Ph.D. or Psy.D.
Active, unrestricted license to practice in Arizona as a behavioral health professional (LCSW, LPC, LISAC, LMFT, licensed psychologist) OR nursing license recognized by the NLC as an RN.
Within 4 years of hire, hold a certification in case management from any of: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator (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 RN‑BC).
Preferred Qualifications
3 years of full‑time direct clinical care experience (managed care case‑management preferred).
1–2 years working in a managed‑care organization.
Bachelor’s Degree in Nursing or Health and Human Services related field.
Active case‑management certification as listed in required qualifications.
ESSENTIAL Job Functions AND RESPONSIBILITIES
Assess and collect data related to the member from all care settings; interview and collaborate with case‑related providers, members, and families to implement the care plan.
Answer a diverse and high volume of health‑insurance related customer calls daily.
Explain to customers information concerning organization services, contract benefits, coverage changes, eligibility, claims, BCBSAZ programs, provider networks, etc.
Analyze medical records and apply medical‑necessity criteria and benefit‑plan requirements to determine appropriateness of benefit requests.
Present status reports on all cases to manager/supervisor and, when indicated, to the medical director.
Consult and coordinate with internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of inquiries.
Meet quality, quantity, and timeliness standards to achieve individual and department performance goals.
Maintain all standards regarding 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 medicine, behavioral health, and managed care at least annually.
Position requires a full‑time work schedule (40 hours/week plus additional hours as needed).
Perform all other duties as assigned.
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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This position is fully remote within Arizona and requires the candidate to reside in the state. The hybrid workforce strategy allows flexibility, but remote employees are not subject to onsite requirements unless specifically requested for business purposes.
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. This job description is primary for case management functions but can assist with utilization management if a business need arises.
Required Qualifications
2 years of full‑time equivalent direct clinical care experience to the consumer.
Associate’s Degree in a general field or Post‑High School Nursing Diploma, Master’s in behavioral health (MSW, MA, MS, M.Ed.), Ph.D. or Psy.D.
Active, unrestricted license to practice in Arizona as a behavioral health professional (LCSW, LPC, LISAC, LMFT, licensed psychologist) OR nursing license recognized by the NLC as an RN.
Within 4 years of hire, hold a certification in case management from any of: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator (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 RN‑BC).
Preferred Qualifications
3 years of full‑time direct clinical care experience (managed care case‑management preferred).
1–2 years working in a managed‑care organization.
Bachelor’s Degree in Nursing or Health and Human Services related field.
Active case‑management certification as listed in required qualifications.
ESSENTIAL Job Functions AND RESPONSIBILITIES
Assess and collect data related to the member from all care settings; interview and collaborate with case‑related providers, members, and families to implement the care plan.
Answer a diverse and high volume of health‑insurance related customer calls daily.
Explain to customers information concerning organization services, contract benefits, coverage changes, eligibility, claims, BCBSAZ programs, provider networks, etc.
Analyze medical records and apply medical‑necessity criteria and benefit‑plan requirements to determine appropriateness of benefit requests.
Present status reports on all cases to manager/supervisor and, when indicated, to the medical director.
Consult and coordinate with internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of inquiries.
Meet quality, quantity, and timeliness standards to achieve individual and department performance goals.
Maintain all standards regarding 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 medicine, behavioral health, and managed care at least annually.
Position requires a full‑time work schedule (40 hours/week plus additional hours as needed).
Perform all other duties as assigned.
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