Manager, Integrated Care (case management) - Hybrid

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

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 position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

Responsible for developing and managing the day to day processes required to provide Care Management (UM and CM) activities that promote quality, cost effective outcomes and remain compliant with all regulatory requirements . This job description includes both utilization management and case management functions with the intent that the manager will be primary in either utilization management or case management.

REQUIRED QUALIFICATIONS

Required Work Experience

• •2 years of experience in full-time equivalent of direct clinical care to the consumer
• •1 year of experience in a supervisory role

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

Once they have directly supervised the integrated care process within (3) years with the organization, 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

• •5 years of experience in full-time equivalent of direct clinical care to the consumer or health insurance field
• •2 years of experience in a supervisory role
• •2 years of experience working in a managed care organization

Preferred Education

Bachelor’s or Master’s Degree in Nursing or Health and Human Services related field of study; or Doctoral degree in behavioral health related field

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).

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• •Manage and oversee all staff activities related to the development and delivery of health improvement/management programs for members with both complex and chronic health care needs.
• •Promotes the integrated, whole-person approach to a continuum of care.
• •Provide oversight and recommendations on the cases being managed through any of the programs.
• •Direct all activities required to maintain accreditation for Case and Utilization Management.
• •Responsible for monitoring and reporting department and program performance measures including IRR. – makes recommendations for improvements to operational practices based on the results.
• •Evaluate, interpret, and negotiate applicable benefit and regulatory requirements.
• •Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
• •Responsible for the review, update and accuracy of documentation, computer files, policies and procedures related to the departmental goals and objectives – makes recommendations for improvements to operational practices based on the
• •Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and implement operational changes and process improvement.
• •Keep status of unit current in accordance with service standards, systems, procedures, forms and manuals through staff meetings, verbal, and written communications.
• •Provide current case management resources and pertinent clinical resources.
• •Facilitate opportunities for staff training, continuing education, and development such as identifying needs, developing curriculum, delivering, and coordinating training. This includes clinical decision making and critical thinking related to member’s care.
• •Ensure that updates related to organizational goals and organizational changes are communicated to staff.
• •Perform a formal evaluation of job performance per Blue Cross Blue Shield of Arizona (BCBSAZ) corporate policy to include review and assessment of the CM program documentation produced by the Care Management staff members.
• •Obtain feedback on support staff job performance from care managers who receive direct support from, and interact on a regular basis
• •Interview, evaluate and make recommendations regarding employment decisions.
• •Participate in continuing education and current developments in the field of medicine, behavioral health, social determinants, and managed care at least annually.
• •The position has onsite expectations of 2 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.

REQUIRED COMPETENCIES

Required Job Skills

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

Required Professional Competencies

• •Maintain confidentiality and privacy in consideration of State, Federal, BCBSAZ and other accreditation requirements
• •Advanced and current clinical knowledge
• •Demonstrates knowledge and understanding of the medical man