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Pediatric Integrated Care Manager-Remote

Company

Blue Cross Blue Shield of Arizona
Address , Phoenix, 85021, Az
Employment type FULL_TIME
Salary
Expires 2023-06-09
Posted at 1 year ago
Job Description
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.
This position is remote within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
    • Answer a diverse and high volume of health insurance related customer calls on a daily basis.
  • Advanced and current clinical knowledge
    • Demonstrate ability to apply plan policies and procedures effectively.
  • Support/mentor team members.
  • Demonstrated organizational skills with the ability to prioritize tasks and work with multiple priorities
    • Follow and accept instruction and direction
  • Knowledge of CPT 2018 and ICD-10 coding
  • 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.
    • Apply independent and sound judgment with good problem solving skills
  • N/A
  • Establish and maintain working relationships in a collaborative team environment
  • Follow and accept instruction and direction
  • Communicate team issues and opportunities for improvement to supervisor/manager;
    • Interpret and translate policies, procedures, programs, and guidelines
  • Bachelor's Degree in Nursing or Health and Human Services related field of study
  • Participate in continuing education and current development in the field of medicine, behavioral health and managed care at least annually.
  • Navigate, gather, input, and maintain data records in multiple system applications
    • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
  • Knowledge of managed care, utilization management, and quality management
  • 1-2 year (s) of experience working in a managed care organization
    • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Perform all other duties as assigned.
  • 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.
  • Practice interpersonal and active listening skills to achieve customer satisfaction
    • Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
  • 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
  • Intermediate PC proficiency
    • Maintain complete and accurate records per department policy.
    • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
    • 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.
  • Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
  • Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements.
  • 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
  • N/A
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
    • Advanced and current clinical knowledge
  • 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.
  • 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer
  • Advanced PC proficiency
    • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Maintain confidentiality and privacy
  • Working knowledge of McKesson InterQual, MCG, ASAM, or other nationally recognized criteria
  • Interpret and translate policies, procedures, programs, and guidelines
  • When indicated to assist with team/project functions: Collaborate with team to distribute workload/work tasks;
  • Capable of investigative and analytical research
  • 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
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • The position 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.
  • Required Qualifications
    1. Required Work Experience
    • 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
    2. 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
    3. 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.
    4. 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).
  • Maintain complete and accurate records per department policy.
  • 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.
  • Represent BCBSAZ in the community
  • Knowledge of a wide range of matters pertaining to the organizations services and operations
  • PREFERRED QUALIFICATIONS
    1. Preferred Work Experience
    • 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer
    • 1-2 year (s) of experience working in a managed care organization
    2. Preferred Education
    • Bachelor's Degree in Nursing or Health and Human Services related field of study
    3. Preferred Licenses
    • N/A
    4. 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).
    • Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements.
    • Demonstrated organizational skills with the ability to prioritize tasks and work with multiple priorities
  • Intermediate skill in word processing, spreadsheet, and database software
  • Answer a diverse and high volume of health insurance related customer calls on a daily basis.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Knowledge of health and/or patient education and behavior change techniques
    • Capable of investigative and analytical research
    • When indicated to assist with team/project functions: Collaborate with team to distribute workload/work tasks;
    • Navigate, gather, input, and maintain data records in multiple system applications
    3. Required Leadership Experience and Competencies
    • Conflict Resolution
    • Represent BCBSAZ in the community
    PREFERRED COMPETENCIES
    1. Preferred Job Skills
    • Advanced PC proficiency
    • Knowledge of CPT 2018 and ICD-10 coding
    2. 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
    3. Preferred Leadership Experience and Competencies
    • N/A
    CORPORATE RESPONSIBILITIES
    Comply with BCBSAZ corporate and departmental policies and procedures, including, but not limited to Code Blue, Compliance, HIPAA, Computer Responsibility, Accreditation Standards, Attendance, Staff Qualifications and Quality Management Accountabilities.
  • 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).
    • Perform all other duties as assigned.
    COMPETENCIES
    REQUIRED COMPETENCIES
    1. 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
    2. Required Professional Competencies
    • Participate in continuing education and current development in the field of medicine, behavioral health and managed care at least annually.
    • The position 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.
  • 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).
  • 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.
  • Conflict Resolution
  • Demonstrate ability to apply plan policies and procedures effectively.
  • Apply independent and sound judgment with good problem solving skills
    • Maintain confidentiality and privacy
  • Monitor and report team tasks;
    • Establish and maintain working relationships in a collaborative team environment
Our Commitment
BCBSAZ 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.