Medical Management Coordinator I (Remote)

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for CareFirst BlueCross BlueShield. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. PurposeResp & Qualifications We are looking for an experienced administrative professional to live and work remotely from within the greater Baltimore/ Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. In this position, you will have direct and measurable impact on the lives of CareFirst members. The Medical Management Coordinator plays a critical role in ensuring members receive timely, appropriate, and coordinated care. This position supports the clinical teams and Care Managers by addressing non-clinical tasks related to care coordination enabling clinical staff to perform at the top of their license. This position includes frequent telephone and email communications with members, providers, and interdisciplinary care teams. Included in these communications are monitoring and managing the Commercial Care Management phone line and email, efficient function within our medical record platform and telephonic outreach to members to assess stability, ongoing care needs and gaps in care While administrative in function, this role is foundational to ensuring members receive the right support at the right time during some of their most vulnerable health moments. Essential Functions

• Provides ongoing internal and external customer support for care management inquiries from members, providers and/or other customers including benefit verification, contact verification, and case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity.
• Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services and transitions to appropriate clinical resources/programs as required.
• Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
• Assists with reporting, data tracking, gathering, and organization of internal, external, discharge and self-referrals.

QualificationsEducation Level: High School Diploma or GED. Experience: 3 years experience in a health care or health insurance setting. Preferred Qualifications Previous experience in a health care/managed care setting or previous customer facing experience, especially in a medical management related department. Knowledge, Skills And Abilities (KSAs)

• Ability to effectively participate in a multi-disciplinary 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.
• Ability to pay attention to the minute details of a project or task.
• Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.

Salary Range: $38,520 - $70,620 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Commercial Risk 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 Please visit our website to apply: www.carefirst.com/careers 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. REQNUMBER: 21817 If you have questions about this posting, please contact support@lensa.com