Resp & Qualifications

PURPOSE: 
This position supports the Inpatient Management clinical teams by handling non-clinical tasks related to preauthorization functions, inpatient care, utilization review, care coordination and/or quality of care, enabling clinical staff to perform at the top of their license. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

ESSENTIAL FUNCTIONS:

• Provides ongoing internal and external customer support for operational inquiries from members, providers and/or other customers including benefit verification, authorization creation and management, claims inquiries and/or case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity.
• Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services and transitions to appropriate clinical resources/programs as required.
• Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
• Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care processes and/or tracking of Peer-to-Peer reviews.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 3 years experience in a health care or health insurance setting.

Preferred Qualifications:

• Previous experience in a health care/managed care setting or previous customer facing experience, especially in a medical management related department. 

Knowledge, Skills and Abilities (KSAs)

• Ability to effectively participate in a multi-disciplinary team including internal and external participants.
• Excellent communication, organizational and customer service skills. 
• Knowledge of basic medical terminology and concepts used in care management.
• Knowledge of standardized processes and procedures for evaluating medical support operations business practices.
• Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
• Ability to pay attention to the minute details of a project or task.
• Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.
• 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.

  Salary Range: $38,520 - $70,620
  

  Salary Range Disclaimer

  The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

  Department

  Short Term Transitional 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.

  Where To Apply

  Please visit our website to apply: www.carefirst.com/careers

  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

  #LI-SS1 

  PDN-a05c1724-b314-4fe6-a951-04feba532316