Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,400 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

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.

 Responsible for developing and managing the day to day processes and staff required to provide Care Management activities that promote quality, improve cost effective outcomes, enhance member satisfaction, support the achievement of business objectives and goalswhile remaining compliant with all BCBSAZ, regulatory and accreditation requirements .

  • Manage and oversee all staff activities related to the development and delivery of health improvement/management programs for members with both complex, acute and chronic health care needs.
  • Responsible for driving process and staffing models to meet or exceed defined department/organizational goals.
  • Provide oversight, recommendations and final direction on the cases being managed through any of the programs.
  • Direct all activities required to maintain accreditation for Case Management.
  • Coordinate and collaborate with clinical benefit management leadership to identify and solve for any challenges/barriers to program success; ensure ongoing compliance with business/contract requirements; develop new policies/procedures or training material necessary for initiative implementation; evaluate existing policies for contract compliance and alignment with current/future state
  • Responsible for tracking, monitoring and reporting department and program performance measures.
  • Evaluate, interpret, and implement department actions based on data and outcomes.
  • Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
  • Responsible for the review, update and accuracy of documentation, computer files, policies and procedures related to the departmental goals and objectives.
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and implement operational changes and process improvement.
  • Keep status of unit current in accordance with service standards, systems, procedures, forms and manuals through staff meetings and verbal and written communications.
  • Coach and mentor staff for professional development and to maintain/enhance staff performance.  
  • Provide motivation and encouragement to subordinates, conduct performance evaluations, identify and coordinate training needs, make determinations regarding disciplinary actions.
  • Interview, evaluate and make candidate recommendations.
  • Represent the Care Management department at meetings and externally with customers.
  • Development and deployment of strategic initiatives, projects and Care Management or organizational initiatives.
  • Create and deploy activities to promote and enhance employee engagement.
  • Participate in continuing education and current developments in the field of medicine 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.
  • Perform all other duties as assigned.
 

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.

Skills / Requirements

Required Work Experience 3  years of experience in management in managed care, health insurance or related health care field Required Education Bachelor’s Degree nursing, healthcare or business related field of study or Masters of Social Work Required Licenses Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN   Required Certifications Once they have directly supervised the case management process for at least three (3) years with the organization, 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). .   Preferred Work Experience 5 year(s) of experience in full-time equivalent of direct clinical care to the consumer or health insurance field 2 year(s) of experience in a supervisory role Preferred Education Master’s Degree in Nursing or Health and Human Services related field of study; or Doctoral degree in behavioral health related field 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 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 Maintain effective working relationships to ensure teamwork in achieving company goals. Foster effective communication with business partners by setting clear directives and providing exchange of ideas. Provide leadership on change management principles to ensure maximize benefit and alleviate unnecessary disruption 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    

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