Blue Cross Blue Shield of Arizona is a local, independent and not-for-profit health 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.
Ensures the Utilization Management Department achieves required service standards by measuring team performance against goals/metrics, directs the flow of work, and identifies opportunities for process improvements.
Required Work Experience
- 3 year(s) of experience in clinical field of practice, health insurance, or other health care related field
- 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)
Preferred Work Experience
- After directly supervising the case mangement process for 3 years, certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Mangement 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).
- 3 year(s) of experience in health insurance field
- Prior supervisory/management experience
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Bachelor's Degree in Nursing or Health and Human Services related field of study
Required Job Skills
- Supervise the day-to-day activities of a unit of employees engaged in medical management activities.
- Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
- Administer, interpret and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.
- Keep status of the unit current in accordance with metrics, systems, procedures, forms and manuals through staff meetings and verbal and written communications.
- Provide motivation and encouragement to subordinates, conduct performance evaluations and monthly reviews, identify and coordinate training needs, make determinations regarding disciplinary actions.
- Interview, evaluate and make recommendations in regard to employment decisions.
- Monitor and investigate computer system issues.
- Assist with analysis of medical records and application of medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests and level of care.
- Assist in the preparation and analysis of cost/benefit and outcomes reports.
- Participate in the activities necessary for preparation and submission of all URAC materials for the accreditation process.
- Participate in continuing education and current developments 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 Professional Competencies
- Intermediate skill in use of office equipment including copier, fax machine, scanner and telephones
- Intermediate PC proficiency
- Intermediate skill in word processing, spreadsheet and database software
Required Leadership Experience and Competencies
- Maintain confidentiality and privacy in consideration of State, Federal, BCBSAZ and other accreditation requirements
- Advanced clinical knowledge, including knowledge of the case management process
- Analytical knowledge to generate reports based on available data and make decisions based on reported data
- Capable of investigative and analytical research
- Practice interpersonal and active listening skills to achieve customer satisfaction
- Skill in composing a variety of business correspondence
- Ability to Interpret and translate policies, procedures, programs and guidelines
- Navigate, gather, input and maintain data records in multiple system applications
- Establish and maintain working relationships in a collaborative team environment with all Departments/Divisions
- Organizational skills with the ability to prioritize tasks and work with multiple priorities
- Independent and sound judgment with good problem solving skills
Preferred Job Skills
- Resolve conflicts
- Represent BCBSAZ in the community
- Make use of employee¿s skills and abilities to deliver business objectives
- Use available information to focus the teams activities and identify priorities
Preferred Leadership Experience and Competencies
- Advanced PC proficiency
- Knowledge of CPT-4 and ICD coding
- Preferred Professional Competencies
- Maintain current thorough knowledge of State, Federal, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions
- Working knowledge of McKesson InterQual® criteria
- Apply supervisory experience to staff management and achieving departmental goals
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com.