Job Description:

This position is responsible for completing the activities outlined in the Client Quality Management Work plan which includes but not limited to: coordination of care between members with gaps in care and the clinical team via building of cases within the electronic health record, reviewing member eligibility for specific quality initiatives, facilitates gap closure activities via inbound and outbound calls to members to engage, educate and transfer for potential program engagement. Assists with tracking gap closure by documenting activities in the care management system and recording data within a spreadsheet.

NATURE AND SCOPE
This role does not manage people
This role reports to this job: Manager, Healthcare Innovation
Necessary Contacts: All levels of BCBSLA personnel; physicians and their office personnel; hospitals and allied health provider administration and personnel, members and Federal Employee Program representatives.

Education
• High School Diploma or equivalent is required
• Two years of college is preferred
Work Experience
• 1 year experience working with Microsoft Office Suite is required
• 1 year of experience communicating with members about clinical topics is preferred
• 3 years of general health insurance, managed care experience and/or prior customer service is preferred
• 4 years of work experience where duties include problem solving and customer satisfaction preferred
• Clinical office experience preferred
Skills and Abilities
• Excellent oral/written communication skills with strong interviewing skills and working knowledge of medical terminology are required
• Must have effective interpersonal skills to handle numerous inquiries in professional manner with tact, diplomacy and patience.
• Excellent listening skills are required to effectively handle customer’s needs/issues and demonstrate the ability to multi-task, prioritize work assignments and work independently.
• Working knowledge of relevant software and proficiency in Microsoft word and excel are required
• Requires the demonstrated ability to identify, make recommendations and take action on opportunities and potential operational efficiencies within the unit and offer solutions and recommendations to management.
• Ability to adhere to defined metrics for monitoring work and preparation of reports to reflect work efforts are required to complete tasks/projects.
• Workplace attitude must embrace customer centric behavior, organizational cultural beliefs and divisional requirements including efficiency, accuracy, adherence and confidentiality of information.
• Punctual and regular attendance is required
• Experience with interacting effectively with health care team members preferred
Licenses and Certifications
• Certification in a medical related field preferred
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
• Works closely with management and staff to facilitate and participate in operational activities, research and implementation of program enhancements, and planning for gap closure initiatives.
• Acts as a resource to the Healthcare Innovations and Care Management training unit for researching, assisting with the delivery of system implementation and general internal and external training activities and maintaining, coordinating and documenting routine staffing activities related to employee satisfaction.
• Provides administrative support which include accurate, timely program data entry, responding to benefit inquiries, completing care coordination activities delegated by clinical staff and maintaining all documentation and reports as determined by management.
• Supports clinical team by researching current and new resource capabilities to identify efficiencies and quality solutions for fulfillment, documentation and member interactions.
• Handles routine telephone calls and incoming and outgoing correspondence and makes outbound telephone calls based on need of targeted population, including but not limited to, QBPC provider and member outreach call and screening for particular quality initiatives.
• Acts as a resource to conduct meaningful member outreach activities, assisting with targeted outreach projects to members and providers that will enhance member engagement in qualifying programs.
• Responsible for meeting targets for staff and unit performance as required by company and management standards.
• Maintain access to applicable data portals and support review of performance data to identify quality improvement opportunities.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions:
• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels. For hybrid or remote work, you must maintain a stable connection and private workspace.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”