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 remote within the state of AZ only. 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.

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.

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, chronic 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 prioritize 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. Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona.