Integrated Care Manager- Adult - Remote-AZ

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.

AZ Blue offersa 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

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.

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.

• 2 years of full-time equivalent experience in direct clinical care to consumers

• 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.
  
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• 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

• 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

• 3 years of direct clinical care experience (managed care case management preferred)
• 1-2 years of experience in a managed care organization

• Bachelor’s Degree in Nursing or Health and Human Services

• None

• Active case management certification (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, RN-BC)

• 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
• Meet quality, productivity, and timeliness standards
• Maintain compliance with state, federal, and accreditation requirements
• Ensure accurate and complete documentation
• Apply policies and procedures effectively

• Assist in workload distribution
• Monitor and report team…