Case Manager-Behavioral Health Registered Nurse (previous CM exper)
Location: Phoenix Arizona
Description: Blue Cross Blue Shield of Arizona is hiring Case Manager-Behavioral Health Registered Nurse (previous CM exper) right now, this vacancy will be placed in Arizona. Detailed specification about this vacancy opportunity kindly read the description below. Introduction
Blue Cross Blue Shield of Arizona is a local, independent and not-for-profit heal! th insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,300 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.
Position Details
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 through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes.
- Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan.
- Answer a diverse and high volume of health insurance related 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 all cases to the manager/supervisor and, when indicated, to the medical director.
- Consult and coordinate with vari! ous 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 achieve individual and department performance goals as defined within the department guidelines.
- Maintain all 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.
- Participate in continuing education and current development 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
2 year(s) of experi! ence in full-time behavioral health clinical care to the consumer
Required Education
- Associate's Degree in general field of study or Post High School Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN).
Required Certifications
- Within 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).
Preferred Work Experience
- 3 year(s) of experience in direct clinical behavioral health care to the consumer
- Bachelor's Degree in Nursing or Health and Human Services related field of study
- Intermediate PC proficiency
- Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
- Intermediate skill in word processing, spreadsheet, and database software
- Maintain confidentiality and privacy
- Advanced and current clinical knowledge
- Practice interpersonal and active listening skills to achieve customer satisfaction
- 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 m! aintain 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
Blue Cross Blue Shield of Arizona does not discriminate in hiring or employment on the basis of race, ethnicity, religion, national origin, sexual orientation, gender, disability, age, covered veteran status or any other protected group.
Thank You
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Blue Cross Blue Shield of Arizona.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Thu, 01 Aug 2013 23:26:33 GMT
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