Care Manager - Baltimore, United States - CareFirst BlueCross BlueShield

CareFirst BlueCross BlueShield

Verified Company

Baltimore, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Resp & Qualifications

PURPOSE:

Under mínimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers.

The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.

This position is considered "remote" meaning that the incumbents generally works outside of a CareFirst location at their Primary Residence within the greater Baltimore Metropolitan, Washington DC or Virginia area.

The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business related activities.

ESSENTIAL FUNCTIONS:

Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to develop a comprehensive plan of care to address the members needs at various stages along the care continuum. Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals.

QUALIFICATIONS:

Licenses and Certifications Required:

RN
Registered Nurse
State Licensure And/or Compact State Licensure.
CCM/ACM or other RN Board Certified certification in case management (Must be qualified to complete exam and obtain certification
within one year of hire).

Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.

Preferred Qualifications:

Bachelors degree in nursing.

Knowledge, Skills and Abilities (KSAs)

Incumbent must have an advanced knowledge of clinical standards of care and disease processes.
Must have the ability to produce accurate and comprehensive work products with mínimal direction.
Must be able to triage immediate member health and safety risks.
Must have a basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
Must have excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
Must be able to provide excellent internal and external customer service.
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:
$69,768 - $138,567

Salary Range Disclaimer

Department

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.

Where To Apply

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

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