Health Manager - RN or RD with CDE/DCES Diabetes Certification

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 QUALIFICATIONS

Required Work Experience

• 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer

Required Education

• Associate’s Degree in general field of study or Post High School Nursing Diploma

Required Licenses

• 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).

• Diabetes Care and Education Specialist (DCES) (formerly Certified Diabetes Educator (CDE))
• 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 QUALIFICATIONS

• 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

• n/a

• Certified Lifestyle Medicine Professional
• Certified Health Coach
• Case Management Certification

ESSENTIAL job functions AND RESPONSIBILITIES

• 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.