Resp & QualificationsPURPOSE:Supports Care Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to care coordination and quality of care. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.Applicants must be bilingual - English and Spanish - in order to meet the needs of our members.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 GEDExperience: 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.
Salary Range: $38,520 - $70,620Salary Range DisclaimerThe 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).DepartmentCHPMD MedicaidEqual Employment OpportunityCareFirst 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 ApplyPlease visit our website to apply: www.carefirst.com/careersFederal Disc/Physical DemandNote: 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 USMust be eligible to work in the U.S. without Sponsorship.#LI-SS1REQNUMBER: 20540
