CareFirst Careers

Post-Acute Transition of Care Specialist

Resp & Qualifications

PRINCIPAL ACCOUNTABILITIES: Under the direction of the Director of the Post-Acute Transitions of Care Program performs the essential duties and responsibilities include but are not limited to, the following:

1. Builds/updates cases per Transition of Care Program policies and procedures. 

  • Assists with case development, verification of benefits/eligibility, discharge/case closures as directed by TCC and/or management. 
  • Builds authorizations for Non TCCI program admissions within 1 Business Day
  • Assists with generation & processing of Transition of Care Program letters.
  • Completes Service Requests for TCCI Inpatient Hospice/SNF within 1 Business Day.


2. Assists with daily facility workload and organization to include:

  • Prioritizes and assigns the appropriate care plan cases to the TCC.
  • Appropriately enters transition note confirming admission to the post-acute care facility.
  • Contacts facilities weekly to obtain discharge dates and enters the appropriate discharge dates, and length of stay in the cases.


3. Communicates and interacts professionally with internal/external customers and providers.

  • Builds and maintains a solid professional relationship with all the targeted facilities including multiple preferred TCCI Partner Providers.
  • Demonstrates knowledge about the Post-Acute Transitions of Care Program Standards in communications with internal/external customers.
  • Investigates and resolves complex, customer and provider service inquiries under Management Guidance.
  • Documents communication/problem resolution in the iCentric System.

4. Responsible for assignments and projects as assigned.

  • Assists with the continuing education for the Post-Acute Transitions of Care Program.
  • Attends mandatory meetings. 
  • Assists with new associate orientation as necessary.
  • Performs administrative duties as assigned.  These duties include, but are not limited to, gathering information, maintaining reports and statistics for the Post-Acute Transitions of Care Program.


QUALIFICATION REQUIREMENTS:

Required Education/Experience:  Requires bachelor’s degree in Business, or health related field.  In lieu of a bachelor’s degree must have 4 years experience in a healthcare related field or work environment.  

In addition:  Must have 1-3 years of experience in health care claims/service areas or office support. Travel will be required in accordance with business needs as directed by Transition of Care Management

Required Abilities/Skills: The incumbent 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. The incumbent must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. The incumbent 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. The Candidate must demonstrate excellent computer skills and knowledge of multiple software systems, such as Microsoft Word, Outlook, and Excel. Must demonstrate excellent oral and written communication skills, time management, and organizational management skills; problem solving skills, and excellent customer service skills.  Must be able to manage concurrent tasks and perform the duties of fellow Transition Care Specialists in their absence.

Preferred: Bachelor’s degree and two years’ experience in health care/managed care setting or previous work experience within CareFirst Medical Management.  A thorough understanding of at least two major BCBS products, services, and benefits.  Additionally, thorough knowledge of BCBS claims payment and service policies. Knowledge of CareFirst IT systems, including knowledge of iCentric, Lotus Notes and expertise using Microsoft Office programs.

Department

Department: Hospital Transition of Care

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: 6/25/2018

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 physical demands described here are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.

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 employee must frequently talk and hear. Weights of 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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