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 supporting members in achieving self-efficacy in managing their health condition(s) through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates self-management strategies and care services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

• 2 years 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

Required Licenses

• 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, or active registration as a Registered Dietician (RD) or Registered Dietitian Nutritionist (RDN), or active registration as a Respiratory Therapist/Respiratory Care Practitioner.

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 3 years of experience in full-time equivalent of direct clinical care to the consumer
• 1-2 years (s) of experience working in a managed care organization
• Experience working with individuals living with chronic conditions such as: Diabetes, CHF, COPD, CAD, CKD, and asthma

Preferred Education

• Bachelor's Degree in Nursing or Health and Human Services-related field of study

Preferred Licenses

• N/A

Preferred Certifications

• Diabetes Care and Education Specialist (DCES) (formerly Certified Diabetes Educator (CDE))
• Certified Lifestyle Medicine Professional
• Certified Health Coach
• Case Management Certification

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Perform assessments, condition management education, training, and other clinically based activities to coordinate care among providers, members, and family to implement the care plan.
• Conduct member-centered planning, including shared goal setting and member-tailored education and interventions to support the member in achieving self-efficacy for condition management.
• Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs.
• Recommend and refer services and resources to members based on their individualized needs, specific health plan, and community and cultural preferences.
• Make and answer a diverse and high volume of condition management-related member calls on a daily basis.
• Explain to members 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, claims data, and other information sources.
• Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
• Consult and coordinate with other Health Managers, various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of member 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 applicable 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, disease self-management, social drivers of health, behavioral health and managed care.
• Represent BCBSAZ and the Health Management Program at member events up to 5% of the time.
• Volunteer within the community to help BCBSAZ give back.
• 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 the use of office equipment, including copiers, fax machines, scanners and telephones
• Intermediate skill in word processing, spreadsheet, and database software

Required Professional Competencies

• Maintain confidentiality and privacy
• Advanced and current clinical knowledge, particularly as it relates to common chronic conditions including asthma, coronary artery disease, chronic kidney disease, chornic obstructive pulmonary disorder, congestive heart failure, and diabetes
• Practice interpersonal and active listening skills to achieve customer satisfaction
• Knowledge of health and/or patient education and behavior change techniques
• 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 condition management, 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

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.

Additional Information

Company: Blue Cross BlueShield Arizona

Location: Arizona

Salary:

Job ID: R6061

Specialties: Managed Care, Diabetes

Required Licenses: RN

Experience Level: 1-3 years