Company: Blue Cross of Idaho
Posted on: May 11, 2019
Under limited supervision, effectively case-manage members
utilizing a collaborative process. Assess, plan, implement,
monitor, and evaluate the options and services required to meet an
individual's health needs using communication and available
resources to promote quality, cost-effective outcomes. Work closely
to coordinate care with providers, primary care teams, and social
services agencies to provide ongoing care coordination, connection
to resources, and support to plan members while improving their
health and general well-being through education and provision of
coordination of care and services. Support providers and Care
Coordination staff through an integrated approach to case
management and community outreach.
--- Responsible for establishing trusting relationships, while
exhibiting excellent working relations, with members, families,
providers, and BCI staff.
--- Communicate to members the purpose of the CHW and the impact it
may have on their well-being. Help members identify socio-economic
issues that affect their overall health and develop health/social
management plans and goals.
--- Provide ongoing follow-up, basic motivational interviewing, and
goal setting with members/families.
--- Conduct in person assessments with members, including
coordinating care with other providers, and/or community resources
and other programs. Motivate members to be active and engaged
participants in their health and overall well-being.
--- Follow-up with members via phone calls and on-site visits.
--- Facilitate coordination for members in accessing appropriate
health related services, community agencies, and providers.
--- Identify opportunities for intervention.
--- Work closely with medical provider to help ensure that members
have comprehensive and coordinated care. Follow-up with members
should be continuous from initial identification through closure.
Coordinate and monitor services, including comprehensive tracking
of members compliance in relation to care plan objectives.
--- Help members review benefit concerns and connect with
appropriate BCI internal resources to expedite resolution of
concerns and inquiries.
--- Work collaboratively with other BCI clinical personnel assigned
to the same member. Responsible for providing consistent
communication to other Care Coordination staff to evaluate
member/family status, ensuring that provided information, and
reports clearly describe progress.
--- Provide support and advocacy during medical care or when
necessary to assure members medical needs and referrals required
are being conveyed. Identify and assist with care coordination
related to Gaps in care.
--- Document all member encounters and contacts made on behalf of
members. Complete and submit monthly reports; maintain
comprehensive electronic member files, which include member notes,
release of information, assessments and other medical documents
acquired on behalf of the member. Document activities, service
plans, and outcomes achieved by member in an effective manner.
--- Attend regular staff meetings, trainings, and other meetings as
--- Travels to on-site locations, various agencies, and other
--- Act as a resource for internal and external customers
--- 3 years' experience within health insurance, health care,
--- Experience with navigating local community resources
--- Associate's degree, preferably in Health Science, Public
Health, Community & Environmental Health, or
other healthcare related field.
--- Preferred degree as Social Worker or LPN or other clinical
designation involved in care coordinating
--- Community agencies and resources
--- Multi-system outreach programs related to health care delivery,
clinical education, and health-related
--- Managed care delivery systems
--- Quality Improvement (QI)
--- Center for Medicare and Medicaid Services (CMS)
--- Long Term Services & Supports (LTSS)
--- Unique aspects of providing services to a Medicaid
We are an Equal Opportunity Employer and do not discriminate
against any employee or applicant for employment because of race,
color, sex, age, national origin, religion, sexual orientation,
gender identity, status as a veteran, and basis of disability or
any other federal, state or local protected class.
Keywords: Blue Cross of Idaho, Meridian , Care Coordinator, Other , Meridian, Idaho
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