Health Manager - RN or RD required
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ 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.
Responsible for supporting members in achieving self-efficacy in managing their health condition(s) through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates self-management strategies and care services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes.
Required Work Experience
- 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
- Associate’s Degree in general field of study or Post High School Nursing Diploma
- 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, or active registration as a Registered Dietician (RD) or Registered Dietitian Nutritionist (RDN).
- Within 4 years of hire, hold a certification in case management from one of the following: Certified Case Manager (CCM), Case Management Administrator Certified (CMAC), Case Management Certified (CMC), Registered Nurse Case Manager, or other approved related certification
PREFERRED QUALIFICATIONSPreferred 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
- Experience working with individuals living with chronic conditions such as: Diabetes, CHF, COPD, CAD, CKD, and asthma
- Bachelor's Degree in Nursing or Health and Human Services-related field of study
- Diabetes Care and Education Specialist (DCES) (formerly Certified Diabetes Educator (CDE))
- Certified Lifestyle Medicine Professional
- Certified Health Coach
- Case Management Certification
- Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan.
- Conduct member-centered planning, including shared goal-setting and member-tailored education and interventions to support the member in achieving self-efficacy for condition management.
- Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs.
- Recommend and refer services and resources to members based on their individualized needs, specific health plan, and community and cultural preferences.
- Make and answer a diverse and high volume of condition management-related member calls on a daily basis.
- Explain to members 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.
- Analyze medical records, claims data, and other information sources.
- Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
- Consult and coordinate with other Health Managers, various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of member inquiries.
- Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
- Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other applicable accreditation requirements.
- Maintain complete and accurate records per department policy.
- Demonstrate ability to apply plan policies and procedures effectively.
- When indicated to assist with team/project functions:
- Collaborate with team to distribute workload/work tasks;
- Monitor and report team tasks;
- Communicate team issues and opportunities for improvement to supervisor/manager;
- Support/mentor team members.
- Participate in continuing education and current development in the field of medicine, disease self-management, social drivers of health, behavioral health and managed care.
- Represent BCBSAZ and the Health Management Program at member events up to 5% of the time.
- Volunteer within the community to help BCBSAZ give back.
- 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.
- Maintain confidentiality and privacy
- Advanced and current clinical knowledge, particularly as it relates to common chronic conditions including asthma, coronary artery disease, chronic kidney disease, chornic obstructive pulmonary disorder, congestive heart failure, and diabetes
- Practice interpersonal and active listening skills to achieve customer satisfaction
- Knowledge of health and/or patient education and behavior change techniques
- Interpret and translate policies, procedures, programs, and guidelines
- Capable of investigative and analytical research
- Demonstrated organizational skills with the ability to priortize tasks and work with multiple priorities
- Follow and accept instruction and direction
- Establish and maintain working relationships in a collaborative team environment
- Apply independent and sound judgment with good problem solving skills
- Navigate, gather, input, and maintain data records in multiple system applications
- Conflict Resolution
- Represent BCBSAZ in the community
PREFERRED COMPETENCIESPreferred Job Skills
- Advanced PC proficiency
- Knowledge of CPT 2018 and ICD-10 coding
- Knowledge of condition management, 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
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.