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Rare Condition Manager

Blue Cross Blue Shield of Arizona

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Location:
United States , Phoenix

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

To support high-quality, cost-effective care by coordinating services for members through comprehensive case management, with a specialized focus on individuals with rare or complex conditions. This role ensures continuity of care by assessing needs, developing care plans, facilitating access to appropriate resources, and collaborating with providers to achieve optimal health outcomes

Job Responsibility:

  • Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan
  • Make and answer a diverse and high volume of condition management-related member calls on a daily basis
  • Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs
  • Analyze medical records, claims data, and other information sources
  • Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, BCBSAZ programs, provider networks, etc
  • Present status reports on cases to the manager/supervisor and, when indicated, to the medical director
  • Consult and coordinate with various 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
  • 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, behavioral health 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

Requirements:

  • 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
  • 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 (or an endorsement to work in Arizona) as an 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
  • 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 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
  • Conflict Resolution
  • Represent BCBSAZ in the community

Nice to have:

  • 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)
  • 1-2 year(s) of experience working in a managed care organization
  • Bachelor's Degree in Nursing or Health and Human Services related field of study
  • Active and current 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)
  • Advanced PC proficiency
  • Knowledge of CPT 2018 and ICD-10 coding
  • Knowledge of 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
  • Knowledge of health and/or patient education and behavior change techniques

Additional Information:

Job Posted:
December 27, 2025

Employment Type:
Fulltime
Work Type:
Remote work
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