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 or GED

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
- Bi-Lingual
  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 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.
    
    Salary Range: $38,520 - $70,620
    Salary Range Disclaimer
    
    The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
    Department
    
    CHPMD Medicaid
    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.
    Where To Apply
    
    Please visit our website to apply: www.carefirst.com/careers
    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 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.
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