Resp & Qualifications
PURPOSE:
Supports Care Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to care coordination and quality of care.
ESSENTIAL FUNCTIONS:
- Assists with member follow up and coordination of care that does not require intervention from a clinician (post discharge or post graduation monitoring; finding appointments; arranging services, etc), enabling clinicians to perform at the top of their license.
- Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services. Transitions to appropriate clinical resources/programs as necessary.
- Provides general support and coordination services for the department including but not limited to answering telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
- Performs member or provider related administrative support which may include benefit verification, authorization management and case documentation.
- Assists with reporting, data tracking, gathering, organization and dissemination of information
QUALIFICATIONS:
Education Level: High School Diploma
Experience: 3 years experience in health care claims/service areas or office support.
Preferred Qualifications:Two years’ experience in health care/managed care setting or previous work experience within division
Knowledge, Skills and Abilities (KSAs)
- Ability to effectively participate in a multi-disciplinary team including internal and external participants
- Excellent communication, organizational and customer service skills
- Knowledge of basic medical terminology and concepts used in care management
- Knowledge of standardized processes and procedures for evaluating medical support operations business practices
- Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy
- Ability to pay attention to the minute details of a project or task
- Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point
- Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Department
Department: Maryland Medcaid Case Management
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Closing Date
Please apply before: 2/9/2022
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship