Integrated Care Manager – prior Health Plan CM experience

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

📋 Description

• Ensure continuity of care by assessing, planning, implementing, coordinating, monitoring, and evaluating care options and services.

• Gather and assess member data across various care settings.

• Collaborate with providers, members, and families through interviews to execute care plans effectively.

• Handle a high volume of diverse customer inquiries related to health insurance.

• Clarify contract benefits, coverage changes, eligibility, claims, BCBSAZ programs, and provider networks.

• Review medical records and apply criteria for medical necessity and benefit plan requirements.

• Provide case status updates to managers, supervisors, and medical directors as necessary.

• Coordinate with internal departments, external plans, providers, businesses, and government agencies to address inquiries.

• Adhere to quality, quantity, timeliness, and departmental performance standards.

• Ensure compliance with state, federal, BCBSAZ, URAC, and other accreditation standards.

• Maintain complete and accurate documentation.

• Effectively apply plan policies and procedures.

• Collaborate on the distribution of team workload and task monitoring when required.

• Communicate team challenges and improvement opportunities to supervisors and managers.

• Provide support and mentorship to team members when necessary.

• Engage in annual continuing education and professional development activities.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of 2 years of full-time equivalent experience in direct clinical care with consumers.

• An Associate’s Degree in a general field of study, a Post High School Nursing Diploma, or a Master's Degree in a behavioral health field; Ph.D. or Psy.D.

• An active, current, and unrestricted Arizona behavioral health professional license, or an active, current, and unrestricted nursing license in Arizona or another U.S. state recognized by the Nursing Licensure Compact (NLC).

• Must obtain a case management certification such as CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN,C, or RN,BC within 4 years of hire.

• Intermediate proficiency in PC usage.

• Intermediate skills with office equipment including copiers, fax machines, scanners, and telephones.

• Intermediate proficiency in word processing, spreadsheet, and database software applications.

• Uphold confidentiality and privacy standards.

• Advanced and up-to-date clinical knowledge.

• Strong interpersonal and active listening abilities.

• Capability to interpret and translate policies, procedures, programs, and guidelines.

• Investigative and analytical research capabilities.

• Strong organizational skills with the ability to prioritize multiple tasks.

• Ability to follow instructions and directives.

• Capacity to establish and maintain collaborative working relationships.

• Independent judgment and problem-solving abilities.

• Proficient in navigating, gathering, inputting, and maintaining data records across multiple applications.

• Conflict resolution skills.

• Ability to represent BCBSAZ within the community.

• Preferred: 3 years of direct clinical care experience.

• Preferred: 1–2 years of experience in a managed care organization.

• Preferred: Bachelor's Degree in Nursing or a related field in Health and Human Services.

• Preferred: Active and current case management certification.

• Preferred: Advanced PC skills.

• Preferred: Familiarity with CPT 2018 and ICD-10 coding.

• Preferred: Knowledge of managed care, utilization management, and quality management.

• Preferred: Working knowledge of McKesson InterQual, MCG, ASAM, or other nationally recognized criteria.

• Preferred: Understanding of organizational services and operations.

• Preferred: Knowledge of health/patient education and behavior change techniques.

🏝️ Benefits

• A hybrid workforce strategy (Workability) providing flexibility in work location and arrangements.

• Remote work opportunities available for Arizona residents without regular on-site requirements.

• Full-time employment with a minimum schedule of 40 hours per week.

• Opportunities for continuing education and professional development in medicine, behavioral health, and managed care.

• Access to training, staff meetings, one-on-ones, and team-building activities as applicable.

• Commitment to equal opportunity and nondiscrimination in hiring and employment practices.