Internship Blue Cross Blue Shield Remote Data Entry Positions

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PURPOSE:

Under minimal supervision, the FEP Care Manager researches and analyzes a member’s medical and behavioral health needs and healthcare cost drivers.

The FEP Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and a positive member experience that leads to optimal health and cost-effective outcomes.

We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington DC metropolitan area.

The incumbent will be expected to come into a CareFirst location periodically for meetings, training, and/or other business-related activities.

ESSENTIAL FUNCTIONS:

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Identifies members with acute/complex medical and/or behavioral health conditions.
Engages telephonically with members, families, 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 members and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address members’ medical, behavioral, and/or social determinants 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:
Licenses and Certifications:

Licenses/Certifications Licenses/Certification Details Time Frame Req Preferred.

RN – Registered Nurse – State Licensure and/or Compact State Licensure RN- Registered Nurse in MD, VA, and Washington, DC Upon Hire Required.

Certified Case Manager (CCM) Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM or other RN Board Certified certification in case management.

Incumbents not certified at the time of hire must have two years of case management experience and meet the requirements to take the CCM or ACM exam and successfully achieve the certification within the first year of employment upon hire.

Experience: The incumbent must be a licensed Registered Nurse upon hire.

Must have 5 years of clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management, or other direct patient care experience.

Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM certification in case management.

Incumbents not certified at the time of hire must have two years of case management experience and meet the requirements to take the CCM exam and successfully achieve the certification within the first year of employment.

Preferred Qualifications:

Bachelor’s degree in nursing
CCM in case management.

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