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: