Remote Integrated Care Manager

Blue Cross Blue Shield of Arizona; Phoenix (AZ); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Blue Cross Blue Shield of Arizona seeks a Care Manager to coordinate member care, assess needs, and promote quality, cost-effective outcomes within Arizona. You will collect data from all care settings, collaborate with providers, and enable effective care planning.

The role emphasizes analyzing medical records for necessity, managing high-volume calls, and ensuring adherence to policies and accreditation standards.

Qualifications

• 2 years of direct clinical care experience.
• Associate’s Degree in general field of study or nursing/behavioral health degree.
• Active license to practice in Arizona as a behavioral health professional or RN, in good standing.

Responsibilities

• Assess and collect data related to the member from all care settings and coordinate with providers to implement the care plan.
• Handle a high volume of health insurance-related calls daily and explain benefits, coverage changes, and provider networks.
• Analyze medical records to determine medical necessity and benefit plan alignment; present status reports to management.
• Collaborate with internal and external stakeholders to resolve inquiries and ensure timely responses.
• Maintain accurate records and ensure compliance with state, URAC, and accreditation standards.

Skills

Case management

Medical records review

Customer service

Interpersonal skills

Education

Associate's Degree or higher

Tools

McKesson InterQual

ICD-10 coding

Job description

Blue Cross Blue Shield of Arizona seeks a Care Manager to coordinate member care, assess needs, and promote quality, cost-effective outcomes within Arizona. You will collect data from all care settings, collaborate with providers, and enable effective care planning.

The role emphasizes analyzing medical records for necessity, managing high-volume calls, and ensuring adherence to policies and accreditation standards.