Manager, Integrated Care (case management) - Hybrid

Blue Cross Blue Shield of AZ; Phoenix (AZ); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Cross Blue Shield of Arizona seeks a Care Management Manager to oversee day-to-day utilization and care management activities, ensuring high-quality, cost-effective outcomes.

The role leads a team in a hybrid-work environment, balancing program development with regulatory compliance and performance improvement initiatives.

Qualifications

• Requires 2 years direct clinical care experience and 1 year supervisory experience.
• Active, current license in AZ as behavioral health professional or RN, eligible to practice in AZ.
• Certification in case management within 3 years of employment is required or achieved thereafter.

Responsibilities

• Oversee development and delivery of health improvement programs for members with complex and chronic needs.
• Promote an integrated, whole-person approach to care.
• Provide oversight and recommendations on cases managed across programs.
• Ensure compliance with regulatory requirements and organizational policies.

Skills

Clinical care

Supervisory experience

Behavioral health

Quality improvement

Education

Associate's degree / Nursing diploma

Master's in behavioral health

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 position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the Job

Responsible for developing and managing the day to day processes required to provide Care Management (UM and CM) activities that promote quality, cost effective outcomes and remain compliant with all regulatory requirements. This job description includes both utilization management and case management functions with the intent that the manager will be primary in either utilization management or case management.

Required Qualifications

Required Work Experience

• 2 years of experience in full-time equivalent of direct clinical care to the consumer
• 1 year of experience in a supervisory role

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

• Once they have directly supervised the integrated care process within (3) years with the organization, 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

• 5 years of experience in full-time equivalent of direct clinical care to the consumer or health insurance field
• 2 years of experience in a supervisory role
• 2 years of experience working in a managed care organization

Preferred Education

• Bachelor's or Master's Degree in Nursing or Health and Human Services related field of study; or Doctoral degree in behavioral health related field

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

• Manage and oversee all staff activities related to the development and delivery of health improvement/management programs for members with both complex and chronic health care needs.
• Promotes the integrated, whole-person approach to a continuum of care.
• Provide oversight and recommendations on the cases being managed through any of the programs.
• Direct all activities re