Integrated Care Manager – Adult

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Facilitate continuity of care through a collaborative approach that evaluates, plans, implements, coordinates, monitors, and assesses available care options and services for members under their benefit plan.

• Ensure care aligns with individual healthcare requirements while promoting quality and cost-effective results.

• Primarily concentrate on case management while providing assistance with utilization management as necessary.

• Evaluate and gather member data from all healthcare settings.

• Partner with providers, members, and families to execute care plans.

• Manage a high volume of health insurance-related customer calls on a daily basis.

• Clarify benefits, coverage, eligibility, claims, programs, and networks to members.

• Review medical records and assess medical necessity based on established criteria and benefits.

• Provide updates on case status to leadership and the medical director as required.

• Coordinate efforts with internal departments, providers, and external organizations.

• Achieve quality, productivity, and timeliness benchmarks.

• Maintain adherence to state, federal, and accreditation regulations.

• Ensure documentation is precise and thorough.

• Effectively implement policies and procedures.

• Assist in the distribution of workloads when necessary.

• Track and report team progress.

• Communicate challenges and opportunities for improvement.

• Provide mentorship and support to team members.

• Commit to a minimum of 40 hours per week; additional hours may be necessary based on business demands.

• Perform additional duties as assigned.

⛳️ Requirements

• Two years of full-time equivalent experience in direct clinical care for consumers.

• An Associate’s Degree in a general field of study OR a Post High School Nursing Diploma OR a Master’s Degree in a behavioral health discipline (MSW, MA, MS, M.Ed.), Ph.D., or Psy.D.

• A current, unrestricted license in Arizona (or eligibility via endorsement) as a behavioral health professional such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.) OR an active, unrestricted RN license in Arizona or a Nurse Licensure Compact (NLC) state.

• Must obtain one of the following case management certifications within four years of hire: CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, or RN-BC.

• Intermediate proficiency with PC skills.

• Intermediate capability in using office equipment (copiers, fax machines, scanners, phones).

• Intermediate skills in word processing, spreadsheets, and databases.

• Ability to maintain confidentiality and privacy.

• Advanced clinical knowledge.

• Strong interpersonal and active listening abilities.

• Capability to interpret and clarify policies and procedures.

• Strong analytical and research skills.

• Organizational skills with the ability to handle multiple priorities.

• Ability to follow instructions accurately.

• Skills in team collaboration.

• Sound judgment and problem-solving capabilities.

• Ability to manage and maintain data across various systems.

• Proficiency in conflict resolution.

• Ability to represent the organization within the community.

🏝️ Benefits

• A hybrid workforce strategy called Workability, providing flexibility regarding how and where employees work.

• Opportunity for remote work with no regular onsite obligations.

• Annual continuing education in healthcare, behavioral health, and managed care.