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
Required Certifications N/A
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 go
Benefits
Health insuranceRemote work options
Additional Information
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.
Bcbsaz · AZ Blue Phoenix, AZ 85021