Care Management Clinical Coordinator, Phoenix, AZ
Job Title Care Management Clinical Coordinator (Registered Nurse, LMSW, LCSW or LMFT required)
Job ID 4598
Full/Part Time Full-Time
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 supporting the Care Management Department by providing professional oversight with an emphasis on Health Management System workflow configuration and documentation, Case Management accreditation, and compliance with State, Federal, BCBSAZ and accreditation guidelines/regulations.
ESSENTIAL job functions AND RESPONSIBILITIES
- Under the direction of the Director develop and document health improvement care management programs for members in compliance with applicable state, federal and accreditation guidelines.
- Conduct analysis of business and user needs in order to develop requirements documentation for the implementation or revision of systems and applications projects for specified business units.
- Working in conjunction with the business users and development teams, responsible for the creation and execution of application test scripts, scenarios, and test plans that validate initial business requirements.
- Consult, collaborate and coordinate with various internal departments, external plans, providers, vendors, businesses and government agencies to obtain information to meet departmental projects and goals. Perform the role of the care management subject matter expert for projects and implementations.
- Create and maintain:
- Job aids, workflows, desktop procedures and policies for the Care Management Department
- Documentation of processes to maintain URAC or other accreditation
- Workflow documents for the health management system
- Reporting of care management activities as required for accreditation, internal or other
- Maintain a strong, supportive working relationship with the Care Management team manager, supervisors and staff. Participate in training Care Management employees for both new employees and new processes.
- Monitor delegated entities for quality and contract requirements; maintain reporting for evaluation and reporting.
- Prepares and presents executive level materials to communicate program activities, results and outcomes as directed.
- Accurately and timely document and record facts in regards to inquiries, correspondences and projects by updating files and Performs staff and program audits and analyzes audit findings. Facilitates the development of action plans as directed by clinical leadership
- Participate in continuing education and current developments in the field of behavioral health and managed care at least annually.
- Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.
- Maintain all standards in consideration of State, Federal, FEP, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions.
- 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.
Required Work Experience
- 3 years of experience in clinical field of practice, health insurance, or other health care related field -health plan experience preferred
- Bachelor’s degree in nursing or Master’s degree in a health-related field
- Active, current, and unrestricted license to practice in the State of Arizona (a State in the United States) as a Registered Nurse (RN) Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW)
Preferred Work Experience
- 5 year(s) of experience in clinical field of practice, health insurance, or other health care related field
- Master’s Degree in Nursing or Health and Human Services related field of study
- Active and current certification in case management (CCM)
- Required Job Skills
- Intermediate knowledge of information systems including Microsoft office suites plus public and proprietary software applications including Visio.
- Intermediate knowledge of health management system software, process automation and configuration
- Advanced writing skills
- Intermediate knowledge of CPT-4, ICD-9 and ICD-10 coding
- Required Professional Competencies
- In-depth knowledge of care and case management programs
- Healthcare payer business knowledge including processes, operational data, and functions to support business
- Maintain confidentiality and privacy
- Analytical knowledge to research and make decisions based on available information to complete activities
- Practice interpersonal and active listening skills to achieve customer satisfaction and departmental communication standards
- Knowledge of managed care delivery models across the continuum of care
- Compose a variety of business correspondence
- Interpret and translate policies, procedures, programs and guidelines
- Establish and maintain working relationships in a collaborative team environment
- Organizational skills with the ability to prioritize tasks and work with multiple priorities
- Independent and sound judgment with good problem solving and critical thinking skills
- Required Leadership Experience and Competencies
- Ability to use available information to focus project’s scope and identify priorities
- Represent BCBSAZ in the community
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.