Manager Case Management (RN, LCSW, LMSW), Phoenix, AZ
Job Title Manager Case Management (RN, LCSW, LMSW)
Job ID 4930
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 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 goals while 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.
Required Work Experience
- 3 years of experience in management in managed care, health insurance or related health care field
- Bachelor’s Degree nursing, healthcare or business related field of study or Masters of Social Work
- Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN); or Licensed Clinical Social Worker (LCSW); or Licensed Master Social Worker (LMSW)
- 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
- Master’s Degree in Nursing or Health and Human Services related field of study; or Doctoral degree in behavioral health related field
Active and current 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).
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.