CareFirst BlueCross BlueShield
Medical Management Coordinator I (Remote)
CareFirst BlueCross BlueShield, Baltimore, Maryland, United States, 21276
Medical Management Coordinator I (Remote)
Join to apply for the
Medical Management Coordinator I (Remote)
role at
CareFirst BlueCross BlueShield
Purpose
This position supports the 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. It will support a better health‑care experience for our Government Programs lines of business and enrollees. The incumbent will work remotely from within the greater Baltimore metropolitan area and will be expected to visit a CareFirst location periodically for meetings, training and other business‑related activities.
Essential Functions
Provides ongoing internal and external customer support for operational inquiries from members, providers and other customers, including benefit verification, authorization creation and management, claims inquiries and case documentation. Assists with member follow‑up and coordination of care that does not require clinician intervention, such as post‑discharge monitoring, appointments, and service arrangement, thereby 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 to identify needed services and transitions to appropriate clinical resources/programs.
Provides general support and coordination services for the department, including answering and responding to telephone calls, taking messages, letters and correspondence, researching information, and assisting in problem solving.
Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care processes and tracking of Peer‑to‑Peer reviews.
Qualifications
Education Level: High School Diploma or GED.
Experience: 3 years in a health‑care or health‑insurance setting.
Preferred: Previous experience in a health‑care/managed‑care setting or a customer‑facing medical‑management department.
Preferred: Experience working with Medicare/Medicaid enrollees.
Knowledge, Skills and Abilities (KSAs):
Ability to participate effectively in a multidisciplinary 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.
Attention to minute details of a project or task.
Advanced knowledge of web‑based technology and Microsoft Office applications (Word, Excel, PowerPoint).
Salary Range
$38,520 - $70,620
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. The Company provides equal employment opportunities to all qualified applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran or disabled status, or genetic information.
Where to Apply
Please visit our website to apply:
www.carefirst.com/careers
Physical Demands
The associate is primarily seated while performing the duties of this position. Occasional walking or standing is required. The associate uses hands regularly to write, type, key and handle or feel small controls and objects. Talking and hearing are frequent requirements. Weights up to 25 pounds are occasionally lifted.
Federal Disqualifying/Physical Demand Note
The incumbent must immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work on federal health‑care programs.
Sponsorship in the U.S.
Must be eligible to work in the U.S. without sponsorship.
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Medical Management Coordinator I (Remote)
role at
CareFirst BlueCross BlueShield
Purpose
This position supports the 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. It will support a better health‑care experience for our Government Programs lines of business and enrollees. The incumbent will work remotely from within the greater Baltimore metropolitan area and will be expected to visit a CareFirst location periodically for meetings, training and other business‑related activities.
Essential Functions
Provides ongoing internal and external customer support for operational inquiries from members, providers and other customers, including benefit verification, authorization creation and management, claims inquiries and case documentation. Assists with member follow‑up and coordination of care that does not require clinician intervention, such as post‑discharge monitoring, appointments, and service arrangement, thereby 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 to identify needed services and transitions to appropriate clinical resources/programs.
Provides general support and coordination services for the department, including answering and responding to telephone calls, taking messages, letters and correspondence, researching information, and assisting in problem solving.
Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care processes and tracking of Peer‑to‑Peer reviews.
Qualifications
Education Level: High School Diploma or GED.
Experience: 3 years in a health‑care or health‑insurance setting.
Preferred: Previous experience in a health‑care/managed‑care setting or a customer‑facing medical‑management department.
Preferred: Experience working with Medicare/Medicaid enrollees.
Knowledge, Skills and Abilities (KSAs):
Ability to participate effectively in a multidisciplinary 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.
Attention to minute details of a project or task.
Advanced knowledge of web‑based technology and Microsoft Office applications (Word, Excel, PowerPoint).
Salary Range
$38,520 - $70,620
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. The Company provides equal employment opportunities to all qualified applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran or disabled status, or genetic information.
Where to Apply
Please visit our website to apply:
www.carefirst.com/careers
Physical Demands
The associate is primarily seated while performing the duties of this position. Occasional walking or standing is required. The associate uses hands regularly to write, type, key and handle or feel small controls and objects. Talking and hearing are frequent requirements. Weights up to 25 pounds are occasionally lifted.
Federal Disqualifying/Physical Demand Note
The incumbent must immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work on federal health‑care programs.
Sponsorship in the U.S.
Must be eligible to work in the U.S. without sponsorship.
#J-18808-Ljbffr