Current Career Opportunities

Responsibilities

• Perform the primary functions of case management–assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy–as appropriate in the health plan context to help members with high health complexity overcome biological, psychological, social and/or health system barriers to improvement and to achieve their desired clinical and functional outcomes.
• Conduct comprehensive assessments and develop personalized care plans in accordance with professional case management and accreditation standards, using evidence-based tools and applying relationship-building, motivational interviewing, risk-prioritization, and other related skills.
• Work collaboratively with members, families, and providers throughout the case management process, drawing upon knowledge of clinical, regulatory, and quality standards, health plan products and benefits, and community resources.
• Support members at all stages of their health care journey and across multiple settings and specialty areas, connecting with multiple providers and community-based organizations; guide members in accessing services to support their health and wellness goals in accordance with their benefits, partnering effectively with the Plan’s customer service, providers relations, and/or utilization management teams.
• Demonstrate a commitment to integrated, multi-disciplinary practice by proactively tapping into the expertise of the Plan’s clinical team of physicians, nurses, mental health clinicians, pharmacists, and colleagues in other departments who can help ensure the best possible experience and outcomes for the member.
• Participate in department and organization-wide initiatives to enhance member health and wellness, improve the quality of care, and generate cost-savings for our customers.

Qualifications

• Graduate of an approved program in professional nursing: RN, VT licensure and ability to apply for Compact License or active multi-state licensure required, BSN desired;
• OR Licensed Clinical Social Worker (LICSW) in the State of Vermont or comparable degree and licensure in an allied mental health profession.
• 5 years of varied clinical practice experience required, preferably in a health care setting. Experience in the following clinical areas strongly desired: inpatient and post-discharge care, management of chronic conditions, including medical and mental health conditions, and substance use disorders.
• 1-3 years of case management or similar experience desired.
• Active CCM certification preferred or initiated within 2 years of hire. Completion of CCM certification required within 3 years of hire.

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Responsibilities:

• Work alongside our clinical review team as part our Utilization Management department

• Verify member benefits, provider networks, and prior approval requirements for authorization of services in a call center environment

Qualifications: 

• Experience working in the medical field as an office assistant, medical coder, or Licensed Nursing Assistant is preferred

• Familiarity with medical terminology is helpful

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Responsibilities

• Acts as a liaison between the Plan’s members, outside vendors, provider offices, other BCBS Plans, and BCBSVT.
• Learn and utilize customer service skills in order to successfully handle all customer interactions in a consistent, courteous, and professional manner.
• Provide clear, concise, and accurate interpretation of Plan certificate language, benefit administration, and internal policies and procedures.  
• Accurately document, track, and research all inquiries in Customer Focus (CF) according to department guidelines and written procedures.
• Identify and initiate appropriate actions required to resolve inquiries.
• Acquire and implement the knowledge and skills necessary to meet individual, department and Company goals that are tied to Career Path and Performance, Quality Assurance, and MTM/Service Index standards.  
• Participate in training as scheduled.

COMPETENCIES (KNOWLEDGE, SKILLS, AND ABILITIES): 

• Subject Matter Expertise 
  o To learn and understand all aspects of Company’s lines of business (LOB), policies and procedures.
  o  Ability to use the knowledge center to access internal desk procedures
• Computer Skills (or other Technical skills) – Ability to maneuver through the web and locate information across multiple sites
• Communication and Interpersonal Skills – Develop interpersonal, oral, and written communication skills.  Understand and uphold the Company’s policy of Confidentiality when dealing with customers and colleagues  
• Organizational Abilities – Work cooperatively with entire CS staff on a daily basis to handle call volume, resolve customer problems and any errors and obtains guidance whenever necessary. Develop the knowledge to work independently with a high degree of accuracy.
• Analytical Skills – Develop and implement the skills necessary to troubleshoot and accurately resolve customer problems.
   

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