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Job Summary

The Medical Management & Outreach Support Specialist will serve as the initial point of telephonic contact between Arkansas Blue Cross Blue Shield CM team and current identified program members for program engagement. This role is responsible for providing non-clinical support to the Exchange Medical Management CM teams as a program liaison responsible for patients throughout the duration of service offerings, including admission to post-discharge care and/or outpatient referrals.

Requirements

EDUCATION

• High school diploma or equivalent.

EXPERIENCE

• Minimum one (1) year office and/or customer support experience interacting with customers via telephone, e-mail, and/or in-person.
• Previous experience in a role requiring an understanding of managed care or Medicaid/Medicare preferred.

ESSENTIAL SKILLS & ABILITIES

• Interpersonal communication
• Oral and written communication
• Problem-solving
• Facilitation skills
• Attention to detail
• Microsoft Office
• Medical terminology

LOCATION

Work from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota. Preference will be given to current employees and candidates who reside in Arkansas, Utah, Idaho, and North Dakota.

Skills

• Action Plan Development
• Analytical Thinking
• Communication
• Detail-Oriented
• Facilitation
• Health Outreach
• Interpersonal Communication
• Medical Terminology
• Problem Solving

Responsibilities

• Assists with case referral process.
• Assists with complex cases member engagement and scheduling
• Attends and actively participates in meetings as required.
• Collaborates, as needed, with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.
• Collaborates with social workers and/or care manager to develop action plan.
• Facilitates communication between all parties (patients, families, colleagues, and community-based organizations) as needed.
• Gathers clinical information regarding case and determines appropriate area to refer or assign case (case management ).
• Maintains and updates tracking databases.
• Performs other duties as assigned.
• Prepares reports and documents clear and concise notes on all actions.
• Promotes engagement and high enrollment with members for case management to help achieve health goals.
• Provides information regarding network providers or general program information when requested.
• Works to identify social determinants of health impacting patient’s health and general well-being.

Certifications

Hiring Range

$16.27 – $21.13

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel – Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.