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Care Manager (Remote)

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Remote

Employer:	CareFirst BlueCross BlueShield
Category:	Health Care Management
Job Type:	Full Time
Description
Resp & Qualifications PURPOSE: Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. This position (based in Washington DC) is considered "hybrid" meaning that the incumbents will work from home part of the work week and come into CareFirst locations and/or CareFirst corporate offices for meetings or training as needed. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages telephonically with member, family and providers to develop a comprehensive plan of care to address the member's needs at various stages along the care continuum. Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals. Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member's medical, behavioral and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member's stabilization and ability to self-manage. Ensures member data is documented according to CareFirst application protocol and regulatory standards. QUALIFICATIONS: Education Level: Associates Degree in Nursing Experience: Must have 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience. License: RN - Registered Nurse - State Licensure And/or Compact State Licensure Preferred Qualifications: Bachelors degree in nursing. CCM Incumbents not certified at the time of hire must have two years of case management or care coordination experience and meet requirements to take CCM exam and successfully achieve the certification within the first year of employment. Knowledge, Skills and Abilities (KSAs) Incumbant must have an advanced knowledge of clinical standards of care and disease processes. Must have the ability to produce accurate and comprehensive work products with minimal direction. Must be able to triage immediate member health and safety risks. Must have a basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits). Must have excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members. Must be proficient in the knowledge of available community resources and programs and Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint. Must be able to provide excellent internal and external customer service. 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. Department Department: 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. Hire Range Disclaimer Actual salary will be based on relevant job experience and work history. 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 #LI-SS1

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