Job Description
Resp & Qualifications PURPOSE:
We are looking for an experienced administrative professional to work remotely from within the greater Baltimore/ Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. In this position, you will have direct and measurable impact on the lives of CareFirst members. The Medical Management Coordinator plays a critical role in ensuring members receive timely, appropriate, and coordinated care. This position supports the clinical teams and Care Managers by addressing non-clinical tasks related to care coordination enabling clinical staff to perform at the top of their license. This position includes frequent telephone and email communications with members, providers, and interdisciplinary care teams. Included in these communications are monitoring and managing the Commercial Care Management phone line and email, efficient function within our medical record platform and telephonic outreach to members to assess stability, ongoing care needs and gaps in care. While administrative in function, this role is foundational to ensuring members receive the right support at the right time during some of their most vulnerable health moments. ESSENTIAL FUNCTIONS
Provides ongoing internal and external customer support for care management inquiries from members, providers and/or other customers including benefit verification, contact verification, and case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity. Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services and transitions to appropriate clinical resources/programs as required. Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems. Assists with reporting, data tracking, gathering, and organization of internal, external, discharge and self-referrals. QUALIFICATIONS
Education Level:
High School Diploma or GED. Experience:
3 years experience in a health care or health insurance setting. Preferred Qualifications:
Previous experience in a health care/managed care setting or previous customer facing experience, especially in a medical management related department. 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:
$39,024 - $71,544 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 responsibilities 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). 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. 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 #LI-NH2
