[Remote] Integrated Care Manager (FEP) (Remote-AZ)

Note: The job is a remote job and is open to candidates in USA. reputed company is committed to inspiring health and making it easy for individuals and families. The Integrated Care Manager is 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, ensuring their health care needs are met while promoting quality and cost-effective outcomes.

Responsibilities

• Assess and collect data reputed company to the member from reputed company care settings. Interview and collaborate with case-reputed company providers, member and family to implement the care plan
• Answer a diverse and high volume of health insurance reputed company 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 reputed company cases to the manager/supervisor and, reputed company 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 reputed company individual and department performance goals as defined reputed company the department guidelines
• Maintain reputed company 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
• reputed company 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 reputed company development in the field of medicine, behavioral health and managed care at least annually
• reputed company reputed company other duties as assigned

Skills

• 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
• 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
• Active, reputed company, 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, reputed company, 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
• reputed company 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)
• 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
• Bachelor's Degree in Nursing or Health and Human Services reputed company field of study
• Active and reputed company 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)

Company Overview

• reputed company is a non-profit company that offers health insurance and financial services. It was founded in 1939, and is headquartered in Phoenix, Arizona, USA, with a workforce of 1001-5000 employees. Its website is https://www.azblue.com.

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