Care Management Extender

Company: Blue Cross Blue Shield of Massachusetts
Location: Quincy
Posted on: August 4, 2022

Job Description:

Ready to help us transform healthcare? Bring your true colors to blue. The care management extender position is a member of the care management team and works collaboratively with nurse case managers to outreach to members who have been identified for case management services through algorithms. The primary function of this position is to place outbound calls and serve as the first point of contact with members who are identified as a potential candidate for case management. The case management extender will conduct a brief assessment scripted based on the reason the member triggered for case management. Once basic information is gathered, all members will be offered the opportunity to speak with a case management nurse. Key to this role is the ability of the care Management extender to engage the BCBSMA member in professional nurse case management. If members agree to participate, the case management extender will schedule timely appointments that meet the members needs directly into the nurse case managers calendar. If members chose not to participate, the case management extender will provide the member with any community resource or case management contact information they may need in the future. All attempts at outreach and conversations with members will be documented in JIVA (BCBS Case Management platform).The care management extender must demonstrate an understanding of the department business objectives and measures including performance guarantees linked to case management engagement rates.KEY RESPONSIBILITIES:+ Engage and motivate members to participate in the various case management programs by clearly articulating the goals, benefits and interventions that can be provided through their insurance benefit 3-5 calls per hour with supporting documentation is the expectation+ Complete a comprehensive assessment tailored to the reason for case management eligibility and refer to nurse case management when member's response triggers criteria for referral and need for licensed clinical intervention/case management+ Provide personalized navigation support to members to help them move through the healthcare system, by ensuring understanding of health plan benefits. This is accomplished by educating and connecting members to resources and support services, including community resources and access to transportation+ Perform outreach to PCP/POC's, specialists, and home care providers to research and facilitate referral of members for services+ Schedules telephone appointments with members to speak with a nurse case manager or assists in scheduling appointments with provider offices at the members request+ Answer all incoming telephone calls to the case management program and assist members to resolve immediate needs real time+ Build cases in case management system when necessary and document reason for case+ Serve as an expert liaison to the Member and Provider Services team (MAPS) representing Health & Medical Management (HMM)+ Manage administrative functions to support program including member mailings, materials etc. as required+ Provides cross coverage of Operational Support Specialists responsibilities to support case management as needed+ Meet or exceed annual performance goal cumulatively for case audits and recorded call audits, where applicable+ Other duties as assigned for business needsQUALIFICATIONS:+ Excellent telephonic skills+ Ability to multi-task and handle inventory+ Independent critical thinking+ Demonstrate adherence to member confidentiality at all times+ Demonstrates strong interpersonal skills that reflects cultural awareness in dealing with members+ Demonstrate ability to respond to needs of other departments as requested+ Demonstrates the ability to build and maintain effective, collaborative work relationships as well as professional and meaningful connections with membersEDUCATION & EXPERIENCE:+ Minimum 2-3 years of customer/member service experience or telephonic health coaching experience is required+ BS/BA or AS/AA degree in healthcare field, education, biological science or related area is preferred or equivalent work experience+ Knowledge of medical terminology required including completion of a certified medical terminology course upon hire+ Experience in a call center strongly, preferredMinimum Education Requirements: High school degree or equivalent required unless otherwise noted above LocationQuincyTime TypeFull timeAt Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month). Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.

Keywords: Blue Cross Blue Shield of Massachusetts, Quincy , Care Management Extender, Executive , Quincy, Massachusetts