Integrated Care Manager - Medicare Advantage (prior CM experience working in a health plan)- Remote
Phoenix, Arizona, United States · Remote OK
Mid level
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Skills: Case Management, Clinical Care, Care Planning, Medical Record Analysis, Medical Necessity Criteria
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Looking to build a lasting career? Join a team that is inclusive and embraces all individuals. Intermountain Centers is one of the largest statewide behavioral health and integrated care organizations in Arizona. What do…
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Residential Licensed Practical Nurse - Tucson, AZ (Desert Garden)
Tucson, Arizona, United States · On-site
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Tucson, Arizona, United States · On-site
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Behavior Intervention Specialist - Tucson, AZ (AIC)
Tucson, Arizona, United States · On-site
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Board Certified Behavior Analyst - Yuma, AZ (BCS-Yuma)
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Mid level
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Board Certified Behavior Analyst (Community Based) - West Valley Phoenix, AZ (BCS Phoenix)
Phoenix, Arizona, United States · On-site
Mid level
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Responsible for promoting continuity of care by assessing, planning, and coordinating care options for members to ensure quality and cost-effective outcomes. The role involves collaborating with providers and families while managing a high volume of health insurance inquiries.
Requirements
Requires at least 2 years of direct clinical care experience and a valid Arizona license as a behavioral health professional or RN. An associate's degree or higher is required, with a case management certification mandatory within four years of hire.
Full 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.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
Purpose of the job
Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes. This job description is primary for case management functions but can assist with utilization management if a business need arises.
Qualifications
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 or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Required Licenses
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an 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.
Required Certifications
Within 4 years of hire as a Care Manager employee must hold a 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
Preferred Work Experience
3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)
1-2 year (s) of experience working in a managed care organization
Preferred Education
Bachelor's Degree in Nursing or Health and Human Services related field of study
Preferred Licenses
N/A
Preferred Certifications
Active and current 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).
ESSENTIAL job functions AND RESPONSIBILITIES
Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan.
Answer a diverse and high volume of health insurance related customer calls on a daily basis.
Explain to customers 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 and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer 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 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, behavioral health 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.
competencies
REQUIRED COMPETENCIES
Required Job Skills
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Required Professional Competencies
Maintain confidentiality and privacy
Advanced and current clinical knowledge
Practice interpersonal and active listening skills to achieve customer satisfaction
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
Required Leadership Experience and Competencies
Conflict Resolution
Represent BCBSAZ in the community
PREFERRED COMPETENCIES
Preferred Job Skills
Advanced PC proficiency
Knowledge of CPT 2018 and ICD-10 coding
Preferred Professional Competencies
Knowledge of 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
Knowledge of health and/or patient education and behavior change techniques
Preferred Leadership Experience and Competencies
N/A
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.
Blue Cross ® Blue Shield ® of Arizona (AZ Blue) is committed to helping Arizonans get healthier faster and stay healthier longer. With a mission to inspire health and make it easy, AZ Blue offers health insurance and related services to more than 2 million customers. AZ Blue, a non-profit company, is an independent licensee of the Blue Cross Blue Shield Association. The company and its subsidiaries employ more than 3,200 people in its Phoenix, Flagstaff, and Tucson offices.
Offices: 8220 N 23rd Ave, Phoenix, Arizona 85021, US
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Based on 446 listings with disclosed salaries, most social services jobs in Arizona pay between $55k–$107k per year. Individual offers vary with seniority, company size, and specialization.
How many Social Services jobs are open in Arizona right now?
There are currently 4,696 open social services positions in Arizona listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Social Services roles in Arizona?
Companies currently hiring include Centria Autism, Community Bridges, Intermountain Centers and its Affiliates: Community Partners, Inc., Pinal Hispanic Council, Action Behavior Centers - ABA Therapy for Autism, Arizona Department of Transportation, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Social Services jobs in Arizona?
Yes — 364 of the 4696 open social services positions offer remote or hybrid work (119 remote, 245 hybrid).
How do I apply for Social Services jobs in Arizona?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.