Resp & Qualifications
The Gender Services Specialist is responsible for supporting the needs of Transgender and Gender Non-Binary members by utilizing key principles of case management and social work. The Gender Services Specialist will research and analyze the member's physical and behavioral 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.
Receives referrals and leverages content expertise to advocate for member needs. Conducts needs assessment with members and providers; gathers, analyzes, synthesizes and prioritizes member needs and opportunities. Identifies relevant CareFirst, provider, and community resources to facilitate program and network referrals.
Outreaches to member or designated representative and providers to engage in the care management program. Collaborates and communicates with member or designated representative on a plan of care that promotes high-quality effective outcomes.
Works collaboratively to review, understand, and inform treatment plans, including alignment with benefits and medical reimbursement policies to facilitate optimal treatment plans, care coordination, and transition of care between settings.
Collaborates with internal cross-functional team members provide consultation as a subject matter expert as needed to internal and external stakeholders, and sssist in development and implementation of new and innovative care models and programs.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: Bachelor's Degree
Education Details: Nursing, Social Work, Psychology, Counseling, Public Health or related field of study
Experience: 5 years experience working with the transgender population
In Lieu of Education: In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Personal experience with the physical and behavioral health needs of the transgender and gender non-binary individuals
1+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience
Knowledge of and or course work in transgender health
Basic understanding of the strategic and financial goals of a health care system or payor organization. Basic understanding of health plan or health insurance operations (e.g. networks, eligibility, benefits).
NCQA or other regulatory familiarity
Knowledge, Skills and Abilities (KSAs) Proficiency
Excellent intercultural communication and relationship management skills
Extensive understanding of transgender community and community resources
Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
Knowledgeable of available community resources and programs.
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.
Licenses and Certifications
One of the following:
RN - Registered Nurse - State Licensure And/or Compact State Licensure
LMAFT - Lic-Marriage & Family Therapy
LCSW- License Clinical Social Worker
LPC - Licensed Prof Counselor
Department: Behavioral Health Care Management
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: 6.24.21
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
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