CareFirst BlueCross BlueShield
Medical Management Coordinator I (Remote)
CareFirst BlueCross BlueShield, Baltimore, Maryland, United States, 21276
Medical Management Coordinator I (Remote)
Purpose
This position supports the Medicaid and Medicare UM clinical teams by handling non-clinical tasks related to preauthorization functions, inpatient care, utilization review, care coordination, and quality of care, enabling clinical staff to perform at the top of their license. The incumbent works remotely from the greater Baltimore metropolitan area and will periodically attend CareFirst meetings and training.
Essential Functions
Provides ongoing customer support for operational inquiries from members, providers, and other customers, including benefit verification, authorization creation, claims inquiries, and case documentation. Assists with member follow up and coordination of care that does not require clinician intervention, including post-discharge monitoring and service arrangement.
Reviews authorization requests for initial determination and triages for clinical review and resolution. Screens, prioritizes members using targeted business rules to identify needed services and transitions to appropriate clinical resources.
Provides general support and coordination services for the department, including answering telephone calls, taking messages, and researching information.
Assists with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care processes and peer-to-peer reviews.
Qualifications Education:
High School Diploma or GED.
Experience:
3 years in a healthcare or health insurance setting.
Preferred Qualifications
Previous experience in a managed care setting or customer-facing experience in a medical management related department.
Knowledge, Skills and Abilities (KSAs)
Effective participation in a multi-disciplinary team with 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 for evaluating medical support operations.
Independent judgment and decision-making with tact and diplomacy.
Attention to detail in projects or tasks.
Advanced knowledge of web-based technology and Microsoft Office applications.
Ability to meet established deadlines and handle multiple customer service demands.
Salary Range $38,520 - $70,620
Department Non-Clinical (Phones and Faxes)
Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity Employer. The company provides 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 Visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand 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.
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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Essential Functions
Provides ongoing customer support for operational inquiries from members, providers, and other customers, including benefit verification, authorization creation, claims inquiries, and case documentation. Assists with member follow up and coordination of care that does not require clinician intervention, including post-discharge monitoring and service arrangement.
Reviews authorization requests for initial determination and triages for clinical review and resolution. Screens, prioritizes members using targeted business rules to identify needed services and transitions to appropriate clinical resources.
Provides general support and coordination services for the department, including answering telephone calls, taking messages, and researching information.
Assists with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care processes and peer-to-peer reviews.
Qualifications Education:
High School Diploma or GED.
Experience:
3 years in a healthcare or health insurance setting.
Preferred Qualifications
Previous experience in a managed care setting or customer-facing experience in a medical management related department.
Knowledge, Skills and Abilities (KSAs)
Effective participation in a multi-disciplinary team with 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 for evaluating medical support operations.
Independent judgment and decision-making with tact and diplomacy.
Attention to detail in projects or tasks.
Advanced knowledge of web-based technology and Microsoft Office applications.
Ability to meet established deadlines and handle multiple customer service demands.
Salary Range $38,520 - $70,620
Department Non-Clinical (Phones and Faxes)
Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity Employer. The company provides 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 Visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand 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.
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.
#J-18808-Ljbffr