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