Care Management- Lead (prior CM/Audit experience in a Health Plan
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.
Assists the Manager, Care Management with performing duties to oversee day-to-day activities within the Care Management Department to facilitate the achievement of business goals and targets. Support management with leading Care Management team to ensure all types of member outreach and documentation completed in compliance with applicable regulations and policies. Identifies and promotes opportunities for process improvements.
- Oversee day-to-day activities of a unit of employees engaged in care coordination/care management activities including supporting the achievement of key performance indicator and inventory management to meet organizational, regulatory and accreditation standards.
- Perform, evaluate, and assist in defining and improving the quality, quantity, outcomes and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
- Administer, interpret and maintain current working knowledge of the required BCBSAZ systems, procedures, forms reports and manuals.
- Keep status of the unit current in accordance with metrics, systems, procedures, forms and manuals through staff meetings, coaching, verbal and written communications.
- Provide motivation and encouragement to employees, document and provide feedback to manager for staff performance evaluations and monthly reviews, identify training needs of employees and develop training plan in consultation/collaboration with employee and manager.
- Participate in interviews, evaluate and make candidate selection recommendations.
- Monitor, investigate and facilitate resolution of computer system/technology issues.
- Assist with member outreach for care management programs. Support the team with workload as needed.
- Assist with the reviewing and updating of department policies, procedures and workflows to ensure quality, efficient processes with accurate documentation and computer files.
- Assist with the implementation of quality assurance process, procedures, and measure for team activities.
- Assist in the preparation and analysis of cost/benefit and outcomes reports.
- Participate in the activities necessary for preparation and submission of all URAC materials for the accreditation process.
- Participate in continuing education and current developments in the field of medicine and managed care at least annually.
- Assist leadership with deployment of strategic initiatives and Perceptyx employee engagement plan
- 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.
- Perform all other duties as assigned.
Required Work Experience
- 5 year(s) of experience in clinical field of practice, health insurance or other health care related field
- Associate’s Degree in nursing or Post High School Nursing Diploma or Masters of Social Work
- Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN); or Licensed Clinical Social Worker (LCSW); or Licensed Master Social Worker (LMSW)
- Within 4 years of hire as a Care Manager and/or Lead employee must hold a certification in case management from the following certifications; Certified Case Manager (CCM), Accredited Case Manager (ACM),Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Rehabilitation Registered Nurse (CRRN), Certified Occupational Health Nurse (COHN), Certified Occupational Health Nurse Specialist (COHN-S), or Registered Nurse Case Manager (RN,BC).
Required Job Skills
- Strong written and verbal communications. Excellent organizational skills and strong attention to detail
- Possess proficient computer and technological skills especially Word, Excel, PowerPoint, SharePoint, Lync/Webinar, Internet and telephone including voice over internet protocol (VoIP)
- Intermediate skill in use of office equipment, including copiers, fax machines, scanners Intermediate skill in word processing, spreadsheet and database software
- Ability to gather, analyze data and prepare informative and accurate business reports
Required Professional Competencies
- Maintain confidentiality and privacy in consideration of State, Federal, BCBSAZ and other accreditation requirements
- Ability to set priorities and appropriately escalate issues to management
- Advanced clinical knowledge, including knowledge of the case management process
- Analytical knowledge to generate reports based on available data and make decisions based on reported data
- Capable of investigative and analytical research
- Practice interpersonal and active listening skills to achieve customer satisfaction
- Skill in composing a variety of business correspondence
- Ability to Interpret and translate policies, procedures, programs and guidelines
- Navigate, gather, input and maintain data records in multiple system applications
- Establish and maintain working relationships in a collaborative team environment with all Departments/Divisions
- Organizational skills with the ability to prioritize tasks and work with multiple priorities
- Independent and sound judgment with good problem solving skills
- Demonstrates ability to identify gaps, communicate gaps and propose possible solutions to close gaps to leadership
- Ability to motivate, coordinate and collaborate effectively with team and stakeholders from multiple business areas
Required Leadership Experience and Competencies
- Make use of employees’ skills and abilities to deliver business objectives
- Use available information to focus the team's activities and identify priorities.
- Resource management skills
- Leadership skills
- Ability to empower employees and encourage innovation and risk taking
- The maturity, communication and influencing skills to assume a lead role in a growing, and changing organization.
- Mindset geared toward the creation, execution and continuous improvement
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.