Integrated Care Manager - Remote AZ

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

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. 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

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. This job description is primary for case management functions but can assist with utilization management if a business need arises.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

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).

PREFERRED 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)
1-2 year (s) 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 Licenses

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

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 has an onsite expectation of 0 days per week and 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.

COMPETENCIES

REQUIRED COMPETENCIES

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 priortize 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 COMPETENCIES

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

Preferred Leadership Experience and Competencies

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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Essential Job Functions: Triages walk-in patients to determine the need for healthcare services and the appropriate disposition of the patient using appropriate assessments guidelines for adult and pediatric patients. Provides any first aid needed until the provider arrives. Maintains emergency supplies and mediations and checks them monthly for expiration dates. Replaces any outdated medication or equipment. Maintains weekly and monthly logs of inspection and testing of emergency equipment ensuring and maintaining compliance with all Joint Commission standards. In partnership with Health Center Manager and Associate Health Center Manager, conducts periodic audits on charts prepared by nursing staff to clarify accuracy. Assigns duties and assist with coordination of nursing services in the assigned unit. Performs and/or completes all clinical and non-clinical assigned duties, tasks, responsibilities, and assignments within reasonable time frames while meeting established rates of performance for the position; ensuring the highest standards of excellence and the lowest error rates in performance of assigned duties. Maintains proficient skill levels that meet defined performance expectations as evidenced by successful completion of competency skills evaluations on an annual basis. Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection control etc. as required for a Registered Nurse. Maintains patient confidentiality by controlling the environment and information being disclosed to authorized individuals ensuring HIPAA and corporate compliance requirements at all times. Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards. Understands and complies with all organizational Code of Conduct standards, Policies and Procedures, Standing Orders, and Service Excellence requirements at all times with all patients, visitors, and employees. Ensures a work environment safe and free from hazards; immediately addresses or informs management of safety issues or hazards; adheres to Health and Safety Policies and Procedures; participates in all safety programs, which may include assignments to an emergency response teams. Completes all of the steps and actions that are defined in the Patient Intake Process, which includes accurately documenting all of the information, patient responses to inquiries and actions taken into the patient’s Electronic Health Record (EHR) prior to the patient seeing a provider. Assists, performs, or completes procedures, and/or activities, within the scope of practice while complying with all Nursing Policies and Procedures. Anticipates, identifies, and responds to the needs of the patient based upon the patient’s reason for the visit, including the coordination and availability of all outside medical records, as well as laboratory and radiology results. Completes all administrative and non-clerical activities, which are received through EHR and/or the Patient Portal in support of clinical operations and completing all required documentation for these activities. Demonstrates at all times a professional attitude and acceptable job performance for all clinical and non-clinical duties, tasks, responsibilities, and assignments at all assigned clinic locations in support of the operational needs of El Rio Health and as assigned by organizational leadership. Evaluates problems, situations, or issues presented whether in a clinical or non-clinical environment for priority needs, resolving the problem effectively and in a timely manner using critical-thinking and problem-solving skills. Completes all Provider Orders ensuring that the patient understands and verbalizes their understanding of the discharge instructions. Documents completed orders and actions taken and entered into the patient’s Electronic Health Record (EHR) and submits for processing within the required time. Ensures that all communication with a patient is completed in a proactive, positive, and effective manner that promotes the patient’s compliance with scheduled appointments and/or treatments and documents in an accurate and timely manner in the patient’s Electronic Health Record (EHR) in accordance with the Nursing Policies and Procedures. Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards for a Registered Nurse. Identifies and reports any safety hazard, or potential hazard, by directly notifying supervisory staff immediately and ensuring that El Rio facilities provide a safe and secure environment for all patients, visitors, and employees; adhere to Health and Safety Policies and Procedures; participate in all safety programs, which may include assignment to an emergency response team. Performs the labeling, rotating, and stocking of all medications, medical supplies, and equipment in compliance with the Nursing Policies and Procedures, maintaining proper and appropriate inventories for operational use. Communicates effectively through written, verbal, and interpersonal skills as applied when interacting with patients or visitors, employees, and internal/external clients or representatives, successfully conveying and exchanging information in a positive manner. Ensures proper documentation and submission of coding relating to all point of care testing, and nursing visits including medications administered, teaching, supplies used and any other interventions to maximize capture of revenue. Ensure and support the cost-effective use of materials, supplies, and equipment by limiting waste of all organizational supplies and resources. In accordance with policies and procedures ensure that documentation of hours worked is completed accurately, as well as signed-off/approved in a timely manner. Through structured learning, peer mentoring and ongoing training opportunities employees must be able to demonstrate an understanding, knowledge, and computer mastery of all El Rio systems and programs. Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position. Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards. Minimum Education and Experience: A Degree or Diploma as a Registered Nurse from an accredited school of nursing, college, or university. One (1) year experience with hands-on patient care nursing, either in a hospital or clinic setting. If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job. Required Licenses, Certifications, and Registrations: Current Registered Nurse license in good standing from the Arizona Board of Nursing. Current certification in Basic Life Support (BLS) for health care providers Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment. Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements. Preferred Education, Experience, Skills, Abilities: Three (3) years’ experience with hands-on patient care nursing, either in a hospital or clinic setting. Bilingual (English/Spanish) with the ability to speak, read and write in both languages. Reasonable accommodations may be made to enable individuals with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices to perform the essential functions of the job. El Rio Health does not discriminate based on race, color, religion, sex (including pregnancy, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors. El Rio Health requires all AZ employees to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. New hires and transfers must submit their fingerprint clearance card or fingerprint receipt before their hire date or transfer date. Level One (1) Non-IVP Fingerprint Clearance card must be received within 30 days after the new employee hire date or transfer date. All employees are strongly recommended to obtain and maintain vaccination status (i.e., as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Subject to exemptions and accommodations when required by law. (Policy: Adm-016 & Adm-045). All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive. El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.