Health Manager - Diabetes Certification - 1 (Remote AZ)

Blue Cross ® Blue Shield ® of Arizona (AZ Blue) is committed to helping Arizonans get healthier faster and stay healthier longer. With a mission to inspire health and make it easy, AZ Blue offers health insurance and related services to more than 2 million customers. AZ Blue, a non-profit company, is an independent licensee of the Blue Cross Blue Shield Association. The company and its subsidiaries employ more than 3,200 people in its Phoenix, Flagstaff, and Tucson offices.

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.

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 has an onsite expectation of 0 days per week and 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.