Job Description

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/hybrid within the state of AZ only

PURPOSE OF THE JOB

Responsible for developing and managing the day to day processes required to provide Integrated Clinical Management support to members that promotes quality, cost effective outcomes, and compliance with all regulatory requirements.

Responsibilities include developing collaborative relationships with community and provider agencies, providing staff training; preparing reports; and monitoring compliance with NCQA, state, and federal regulations. . The Supervisor, Integrated Care Management leads a team of Integrated Care Managers with nursing and behavioral healthcare backgrounds. The position is focused on ensuring the Care Management department achieves required service standards by measuring team performance against goals/metrics, directs the flow of work, and identifies opportunities for process improvements while meeting the goals of the population health model.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· Minimum: 5 years of combined experience in nursing, behavioral healthcare, or health plan care management

· 1-2 years prior supervisory experience

· 2 years experience in direct clinical care

2. Required Education

· Bachelor’s Degree with a Current Arizona registered nurse (RN) license; OR

3. 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)

4. Required Certifications

· After directly supervising the care management process for 3 years, certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case

Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN),

Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN, BC).

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· 3 year(s) of experience in managed care

· 3 years experience in direct clinical care

· 3 plus years prior supervisory/management experience

2. Preferred Education

· Bachelor’s Degree in Nursing or Health

3. Preferred Licenses

· N/A

4. Preferred Certifications

Certified Case Manager (CCM), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN, BC)

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· Supervise the day-to-day activities of employees engaged in care management activities

· Direct all activities required to maintain NCQA accreditation

· Hire, train, mentor and support Integrated Care Managers and support staff

· Act as a clinical resource to staff by reviewing cases and making recommendations on member care

· Assign caseloads and monitor productivity of Integrated Care Managers and support staff

· Complete assigned deliverables accurately and timely

· Develop and implement resources and systems to support the Population Health model and all related care management objectives.

· Write and maintain policies and procedures for the Integrated Care Management Program and related care management protocols

· Communicate information regarding the Integrated Care Management Program and related care management protocols to network providers and stakeholders through provider site visits, committee meetings, and email

communications

· Attend and participate in all team meetings and interdisciplinary care team rounds

· Meet quality, quantity, and timeliness standards to achieve individual and department performance goals

· Maintain all standards in consideration of state, federal, Medicaid Business Segment, NCQA, and other accreditation requirements

· Assist in the preparation and analysis of cost/benefit and outcomes reports.

· Participate in the activities necessary for preparation and submission of all NCQA materials for the accreditation process.

· 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 AHCCCS Medicaid and Medicare, especially MA D-SNP

· Knowledge of NCQA, CMS Model of Care, and Medicaid Standards

· Knowledge of the principles and benefits of integrated health care

· Knowledge of common chronic health conditions and their treatment

· Skilled at thinking critically and developing new processes and efficiencies

· Skilled at using Microsoft Office applications, especially Excel

· Ability to use basic data analysis tools to evaluate and report on program outcomes

· Ability to use and manipulate large volumes of member data

· Ability to work effectively in a team model

· Ability to maintain confidentiality, privacy and security of protected health information and proprietary information

2. Required Professional Competencies

· Advanced clinical knowledge, including knowledge of the care management process

· Experience managing complex and unique caseloads for persons with both physical and behavioral health needs

· Demonstration of independent and sound judgement with good problem-solving skills.

· Ability to teach and train other professionals on clinical processes

· Ability to perform investigative and analytical research.

· Ability to navigate and document activities accurately and timely in multiple system applications

· Ability to establish and maintain working relationships in a collaborative team environment with all departments and divisions

· Ability to communicate professionally in written and oral formats

· Ability to interpret and translate polices, procedures, programs and guidelines

· Ability to deliver presentations to large groups

· Ability to prioritize and effectively handle multiple projects

3. Required Leadership Experience and Competencies

· Ability to resolve conflicts

· Ability to represent BCBSAZ in the community

· Ability to identify, develop and maximize team skills and abilities to deliver business objectives

· Ability to analyze data and available information to prioritize and focus the team’s activities

PREFERRED COMPETENCIES

1. Preferred Job Skills

· Advanced PC proficiency

2. Preferred Professional Competencies

· Current thorough knowledge of State, Federal, BCBSAZ and other applicable regulatory or accrediting agency requirements as they apply to department functions

3. Preferred Leadership Experience and Competencies

· Apply supervisory experience to staff management and achieving organizational goals

Our Commitment

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.

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!

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