Coordinator, Care Management I (Remote)

Resp & Qualifications PURPOSE... Supports Care Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to care coordination and quality of care. 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: 30% 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. 25% Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services. Transitions to appropriate clinical resources/programs as necessary. 20% 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. 20% Performs member or provider related administrative support which may include benefit verification, authorization management and case documentation. 5% Assists with reporting, data tracking, gathering, organization and dissemination of information SUPERVISORY RESPONSIBILITY: Individual Contributor - SCOPE Freedom to Act Work is closely managed and reviewed for accuracy and adequacy. Follows specific, outlined, and detailed directions. Problem Complexity and Problem Solving Timeframes Provides resolution to problems that are readily identifiable with limited scope and are resolved in accordance with standard practices, procedures, applications or routines. Problem/Task resolution timeframe: The majority of tasks typically take one to two days to resolve. Level of Supervision Received Under immediate supervision, performs assigned tasks only as instructed, subject to regular check of performance. Impact Failure to accomplish results can normally be overcome without significant effect on the organization Contact with Others Contacts are primarily within the department or function with occasional cross-functional interfaces. Some limited external customer contact on routine matters.

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 or GED Education Details: Experience: 3 years experience in health care claims/service areas or office support. In Lieu of Education

Preferred Qualifications

Two years' experience in health care/managed care setting or previous work experience within division Knowledge, Skills and Abilities (KSAs) Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient Excellent communication, organizational and customer service skills. , Proficient Knowledge of basic medical terminology and concepts used in care management., Proficient Knowledge of standardized processes and procedures for evaluating medical support operations business practices., Proficient Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy. , Proficient Ability to pay attention to the minute details of a project or task, Proficient Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point, Proficient The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care 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/Certifications Salary Range: $37,872 - $69,432 Physical Demands Standing: Occasionally Walking: Occasionally Sitting: Constantly Lifting: Rarely 20 lbs Carrying: Rarely 20 lbs Pushing: Rarely 20 lbs Pulling: Rarely 20 lbs Climbing: Rarely 20 lbs Balancing: Rarely Stooping: Rarely Kneeling: Rarely Crouching: Rarely Crawling: Rarely Reaching: Rarely Handling: Occasionally Grasping: Occasionally Feeling: Rarely Talking: Constantly Hearing: Constantly Repetitive Motions: Frequently Eye/Hand/Foot Coordination: Frequently Working Environment Extreme cold: Rarely Extreme heat: Rarely Humidity: Rarely Wet: Rarely Noise: Constantly Hazards: Rarely Temperature Change: Rarely Atmospheric Conditions: Rarely Vibration: Rarely Travel Requirements Estimate Amount Apply Job!