Job Description

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.

PURPOSE OF THE JOB

The medical management specialist is responsible for completing initial and concurrent reviews of behavioral health settings. They are also responsible for ensuring members have an appropriate discharge plan and that aftercare services are coordinated.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 2 years of experience in the behavioral health field

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. and independent license in the behavioral health profession.

3. Required Licenses

· Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including LPN, RN, LCSW, LPC, LISAC LMFT, Psy.D. or Ph.D.

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· Preferred experience with prior authorization and concurrent review process

2. Preferred Education

· Master’s degree in a behavioral health field

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· Conducts initial and concurrent reviews for behavioral health inpatient hospitals, out of home treatment and other BH requiring authorization.

· Assessment of post discharge needs and coordinates of services.

· Refers members to care management and disease management programs.

· Maintains accurate clinical documentation of authorizations, case management, concurrent review and discharge.

· Serves as subject matter expert for behavioral health inpatient care, and as a resource for program specialties, including cultural appropriateness. Provides support and technical assistance to providers.

· Consults with Medical Director as necessary.

· Perform all other duties as assigned

· 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

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Knowledge of Arizona Medicaid system and behavioral and AHCCCS health systems

· Psychiatric and substance abuse diagnose

· Psychiatric medications and standards of care

· Medical necessity criteria

· Managed care principles

· Ability to prioritize and effectively handle multiple projects

· Use of a variety of computer-based technologies including Microsoft Office applications

· Understanding of medical records and UR systems

· Ability to type 35 word per minute.

· Excellent computer skills navigating various systems/platforms and skills using Microsoft Office Suite

2. Required Professional Competencies

· Communicate effectively both verbally and in writing

· Ability to work effectively and efficiently as a team member or independently

· Strong interpersonal skills

· Critical thinking, ability to make independent decisions and refer to others as necessary

· Excellent writing and documentation skills and customer service

3. Required Leadership Experience and Competencies

· N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

· N/A

2. Preferred Professional Competencies

· N/A

3. Preferred Leadership Experience and Competencies

· N/

Our Commitment

AZ Blue 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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online