A great place to work. We mote like family than coworkers. Great incentive and pay. Great flexible hours and plenty overtime. We had others back and worked well together!
Pros and Cons
Awesome place to work
Better equipment to work with
Coordinator, Care Management II (MD Medicaid)
CareFirst BlueCross BlueShield - Owings Mills, MD
Coordinator, Care Management II (MD Medicaid)
CareFirst BlueCross BlueShield 
Owings Mills, MD 
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124
Care Coordination Manager
jobs252
jobs in
Owings Mills, MD
12
jobs at
CareFirst BlueCross BlueShield
Job
Company
Description
Salary
Skills
Job Description
Resp & Qualifications
PURPOSE:
Supports clinical teams and Management with more complex coordination tasks and special projects. Assists with non-clinical administrative tasks and responsibilities related to care coordination and quality of care. Acts as a mentor to less seasoned team members.
ESSENTIAL FUNCTIONS:
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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.
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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.
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Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services. Transitions to appropriate clinical resources/programs as necessary.
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Performs member or provider related administrative support which may include benefit verification, authorization management and case documentation.
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Assists clinical teams and/or Management with more complex departmental operations matters including but not limited to special projects and audits.
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Mentors less seasoned team members and/or helps to onboard new team members.
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Assists with reporting, data tracking, gathering, organization and dissemination of information
QUALIFICATIONS:
Education Level: High School Diploma
Experience: 5 years experience in health care claims/service areas or office support.
Preferred Qualifications: Previous experience in health care/managed care setting and previous work experience within Care Management department at CareFirst
Knowledge, Skills and Abilities (KSAs)
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Ability to effectively participate in a multi-disciplinary team including internal and external participants.
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Excellent communication, organizational and customer service skills.
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Knowledge of basic medical terminology and concepts used in care management.
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Knowledge of standardized processes and procedures for evaluating medical support operations business practices
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Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
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Ability to pay attention to the minute details of a project or task
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Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point
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Strong organizational skills to manage multiple projects, issues and priorities.
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Ability to mentor and coach less seasoned team member or act in a team lead or trainer capacity when needed.
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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: Maryland Medicaid Case 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
REQNUMBER: 16430
This job was posted on Wed Apr 27 2022 and expired on Sat Apr 30 2022.
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Reviews
Owings Mills, MD - June 23, 2021
- March 16, 2023I also did some database testing and REST API testing using Postman as well. I worked for CareFirst in the Provider Directory as an API test automation engineer. CareFirst Insurance provides multiple APIs that allow users to access and manage various aspects of their insurance accounts. The services include Health care service, Location search, organization, Practitionar. For example: if we need to verify any location. After receiving the end point, we did hit the end point. After hitting the Api endpoint, we could easily verify the location.
Pros and Consfree lunch, yearly party.no bad side - March 2, 2022I was able to experience multiple job opportunities and increase my knowledge, skills and abilities in the almost 37 years working there,
Pros and ConsGreat benefitsRetiree Health Insurance was way too expensive
Summary
Founded in 1934, CareFirst BlueCross BlueShield is the prominent and financially strong healthcare insurer. Headquartered in Baltimore, MD. CareFirst is a not for profit healthcare company and offers a comprehensive portfolio of health insurance products and administrative services to 3.4 million individuals and employers in Maryland, the District of Columbia, and Northern Virginia. In 2019, CareFirst invested $43 million to improve overall health and increase safety and quality of healthcare throughout its market areas and employs nearly 7,500 associates in Maryland, Washington, D.C and Northern Virginia. It serves over 624,000 members under the Federal Employees Health Benefits Program and offers Employees and their family’s access to more than 96 percent of hospitals and 95 percent of doctors and specialists around the U.S. Care First earned recognition as one of the World's Most Ethical Companies from the Ethisphere Institute in eight consecutive years. The company is always seeking talented associates.
How do you prioritize tasks in a fast-paced environment?
Answer
I prioritize tasks by assessing urgency, importance, and impact on patient care. I use a systematic approach to ensure efficient coordination and timely resolution of issues.
How do you handle conflicts between healthcare providers and patients?
How do you ensure compliance with healthcare regulations and policies?
About the Care Coordination Manager role
Health Services Managers Care Coordination Manager
As Care Coordination Managers, we direct the day to day operations for the Care Coordination team. We work with the interdisciplinary and Administrative Team. We help to align Care Coordination operations with the Operating Unit goals. We collaborate with the Utilization Management Physician Advisor and Medical Director. We manage the implementation of a standardized approach for care coordination processes. We develop and maintain subject matter expertise in care coordination. We supervise the implementation of the enterprise care coordination. We provide leadership for clinical improvement and care delivery enhancement.
Core tasks:
- coordinate care management services with patients
- oversee prior authorization requests and support for follow-up appointments
- oversee the daily operations, staffing, and workflows for the Care Management Department
- ensure the seamless coordination of care
- communicate with the patient's primary Care Provider (PCP), specialists
- audit Visit Notes for specific clinical documentation
- oversee all patient education activities
- lead the team in continuous process improvement activities
124 Care Coordination Manager jobs in Owings Mills, MD
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