Job Description
Resp & Qualifications
Supports clinical teams, Management, and External Clients with the Maryland Special Needs Population with more complex coordination tasks and special projects. Assists with non-clinical administrative tasks and responsibilities related to care coordination and quality of care. Acts as a mentor to less seasoned team members. Will be coordinating services for children and adults with special healthcare needs and assist with scheduling physical and behavioral health services. Acts as liason on consumer advisory board with the membership and other plan associates. Be skilled in communications with, and sensitive to the unique needs of, members of special needs populations, their families, guardians, and caregivers.
ESSENTIAL FUNCTIONS
- Assists with member follow up and coordination of care that does not require intervention from a clinician (post discharge or post graduation monitoring; finding appointments; arranging services, etc), enabling clinicians to perform at the top of their license.
- Provides general support and coordination services for the department including but not limited to answering telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
- Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services. Transitions to appropriate clinical resources/programs as necessary.
- Performs member or provider related administrative support which may include benefit verification, authorization management and case documentation.15%Assists clinical teams and/or Management with more complex departmental operations matters including but not limited to special projects and audits.10%Mentors less seasoned team members and/or helps to onboard new team members.
- Assists with reporting, data tracking, gathering, organization and dissemination of information.
QUALIFICATIONS
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 :High School Diploma
Experience: 5 years experience in health care claims/service areas or office support. Preferably public health experience.
Preferred Qualifications: Previous experience in health care/managed care setting and previous work experience within Care Management department at CareFirst
Knowledge, Skills and Abilities (KSAs)
Ability to effectively participate in a multi-disciplinary team including internal and external participants.AdvancedExcellent communication, organizational and customer service skills.
Knowledge of basic medical terminology and concepts used in care management.AdvancedKnowledge of standardized processes and procedures for evaluating medical support operations business practices.AdvancedExcellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
Ability to pay attention to the minute details of a project or taskAdvancedAdvanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power PointAdvancedStrong organizational skills to manage multiple projects, issues and priorities.
Ability to mentor and coach less seasoned team member or act in a team lead or trainer capacity when needed.
Department
Department: Maryland Medicaid Case 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
Closing Date
Please apply before: 2/1/2022
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
REQNUMBER: 15463
This position is open. This job was posted on Thu Dec 16 2021 and expires on Sat Jan 15 2022.
Tasks
- Maintain accurate, detailed reports and records.
- Administer medications to patients and monitor patients for reactions or side effects.
- Record patients’ medical information and vital signs.
- Monitor, record, and report symptoms or changes in patients’ conditions.
- Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans.
- Modify patient treatment plans as indicated by patients’ responses and conditions.
- Monitor all aspects of patient care, including diet and physical activity.
- Direct or supervise less-skilled nursing or healthcare personnel or supervise a particular unit.
- Prepare patients for and assist with examinations or treatments.
- Instruct individuals, families, or other groups on topics such as health education, disease prevention, or childbirth and develop health improvement programs.
- Assess the needs of individuals, families, or communities, including assessment of individuals’ home or work environments, to identify potential health or safety problems.
- Prepare rooms, sterile instruments, equipment, or supplies and ensure that stock of supplies is maintained.
- Refer students or patients to specialized health resources or community agencies furnishing assistance.
- Consult with institutions or associations regarding issues or concerns relevant to the practice and profession of nursing.
- Inform physician of patient’s condition during anesthesia.
- Administer local, inhalation, intravenous, or other anesthetics.
- Provide health care, first aid, immunizations, or assistance in convalescence or rehabilitation in locations such as schools, hospitals, or industry.
- Hand items to surgeons during operations.
- Observe nurses and visit patients to ensure proper nursing care.
- Conduct specified laboratory tests.
- Direct or coordinate infection control programs, advising or consulting with specified personnel about necessary precautions.
- Engage in research activities related to nursing.
- Prescribe or recommend drugs, medical devices, or other forms of treatment, such as physical therapy, inhalation therapy, or related therapeutic procedures.
- Order, interpret, and evaluate diagnostic tests to identify and assess patient’s condition.
- Perform physical examinations, make tentative diagnoses, and treat patients en route to hospitals or at disaster site triage centers.
- Perform administrative or managerial functions, such as taking responsibility for a unit’s staff, budget, planning, or long-range goals.
- Provide or arrange for training or instruction of auxiliary personnel or students.
- Work with individuals, groups, or families to plan or implement programs designed to improve the overall health of communities.
Skills
- Reading Comprehension – Understanding written sentences and paragraphs in work related documents.
- Active Listening – Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Writing – Communicating effectively in writing as appropriate for the needs of the audience.
- Speaking – Talking to others to convey information effectively.
- Critical Thinking – Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Active Learning – Understanding the implications of new information for both current and future problem-solving and decision-making.
- Learning Strategies – Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things.
- Monitoring – Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
- Social Perceptiveness – Being aware of others’ reactions and understanding why they react as they do.
- Coordination – Adjusting actions in relation to others’ actions.
- Instructing – Teaching others how to do something.
- Service Orientation – Actively looking for ways to help people.
- Complex Problem Solving – Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Judgment and Decision Making – Considering the relative costs and benefits of potential actions to choose the most appropriate one.
Knowledge
- Customer and Personal Service – Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
- Computers and Electronics – Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
- Mathematics – Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
- Biology – Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
- Psychology – Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
- Sociology and Anthropology – Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures and their history and origins.
- Medicine and Dentistry – Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
- Therapy and Counseling – Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.
- Education and Training – Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
- English Language – Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Health Insurance
CareFirst BlueCross BlueShield
Type
Company – Private