Resp & Qualifications
ONCOLOGY EXPERIENCE HIGHLY PREFERRED!
PURPOSE: In support of the CareFirst mission of providing affordable health insurance and accessible health care services, and utilizing key principles of case management, the High Cost Claimant Unit RN Specialist will research and analyze the member’s health needs and health care cost drivers and will work closely with an interdisciplinary care team to ensure members have an effective plan of care that leads to optimal, cost-effective outcomes. Leveraging clinical expertise, strong critical thinking skills and a keen understanding of the business operations of a health plan organization, the High Cost Claimant Unit RN Specialist will work closely with the member and their family to avoid unnecessary hospitalizations and emergency department utilization, optimize site of care whenever possible, and ensure evidence-based treatment is being applied. An experienced case manager with managed care and/or health plan experience and an interest in health economics will be most successful in this role.
PRINCIPAL ACCOUNTABILITIES: Under the general direction of the Director of Care Management, the incumbent’s accountabilities include, but are not limited to, the following:
Required Education/Skills/Abilities: This a position where the incumbent must be capable of working with minimal oversight, showing keen attention to detail and making critical decisions to ensure members have an effective plan of care that leads to optimal, cost-effective outcomes.
• Registered nurse with current Maryland, Virginia or DC license and with no restrictions
• 5 years relevant clinical care experience
• CCM Certificate, or ability to obtain within 1 year of starting in the position
• Exhibits interest in and basic understanding of health economics. Embraces the corporate mission to ensure access to affordable care and applies clinical knowledge and skills with the business operations framework
• Excellent telephonic skills
• Keen business skills – understands business operations in a health plan or health care payor organization
• Excellent verbal and written communication skills
• Excellent conceptual thinking skills
• Excellent relationship management skills – ability to interface effectively with various types of levels of providers and CareFirst colleagues across multiple disciplines
• Excellent organizational skills (ability to prioritize, time management, workflow management)
• Computer application proficiency
• Strong resiliency and flexibility skills
• Excellent research, analytical, and creative problem-solving skills
• Flexibility to work varied hours
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.
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
Please apply before: 1/24/2020
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.
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