Resp & Qualifications
NOTE: This positions supports the Medicare Advantage DSNP program
Reports to the Supervisor for Case Management Assistants and performs duties that support the case management role. Assists with coordinating patient referrals, member and physician letters/mailings, provider faxes, and member calls. Processes authorizations, enters complex clinical data into the care management databases, and submits forms to various entities to further assist the Case Management team. Participates in various department projects and meetings.
Essential Job Duties and Responsibilities:
• Serves as a point of contact for health care services and referrals for members with medical and behavioral health needs.
• Reviews encounter forms/claims to identify all potential case management service needs and collaborates with RN case managers, ensuring member-focused treatment planning, and addressing physical, behavioral and psychosocial needs.
• Works closely with case managers, case manager assistants, and other care coordination departments, integrating case management to meet the needs in the bullet above.
• Collaborates with members, families, and healthcare providers to enhance patient wellness and facilitate connecting members to care.
• Maintains educational materials, assists with member mailings, remains knowledgeable of member benefits/resources, and supports the case management team in various other duties.
• Monitors member compliance telephonically and is available to provide consultation as needed.
• Develops, implements, and maintains case management support programs to facilitate the use of appropriate medical and community resources, and collaborate with providers.
• Documents all activities in the appropriate system(s) in a timely way.
• Assists, as needed, in quality initiatives for department.
• Other duties as assigned.
Education, Experience and Qualifications:
• An education level normally acquired with the completion of an AA Degree in business, healthcare, or the equivalent in healthcare work experience preferred.
• 2-3 years of managed care or insurance industry experience preferred.
• Experience in care coordination, case management, disease management, hospital/acute care setting, or customer service preferred.
• Knowledge of State and Local regulations and community resources a plus.
Department:MD Medicaid -HEALTH SERVICES
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: 4/15/21
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