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Resp & Qualifications

PURPOSE:

Supports Pharmacy Quality clinical teams by assisting with non-clinical administrative tasks and responsibilities related to care coordination, member outreach, and provider/pharmacy engagement to improve Quality measure performance related to Pharmacy.

Although this position is REMOTE, candidates are preferred to live in the MD, DC, VA area in order to travel into our local offices.

ESSENTIAL FUNCTIONS:

+ Assists with member follow up and coordination of care that does not require intervention from a clinician (refilling prescriptions; finding appointments; calling providers and pharmacies; arranging services, etc.), enabling clinicians to perform at the top of their license.

+ Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services. Transitions to appropriate clinical resources/programs as necessary.

+ Provides general support and coordination services for the department including but not limited to answering inbound telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.

+ Performs member or provider related administrative support which may include benefit verification, and case documentation.

+ Assists with reporting, data tracking, gathering, organization and dissemination of information.

QUALIFICATIONS:

**Education Level:** High School Diploma or GED.

**Experience:** 3 years experience in a health care claims/service areas, health care office support, or pharmacy.

Preferred Qualifications:

Previous experience as a pharmacy technician or in a health care/managed care setting or previous customer facing experience, especially in a medical management related department.

Knowledge, Skills and Abilities (KSAs)

+ Ability to effectively participate in a multi-disciplinary team including internal and external participants.

+ Must be able to effectively communicate and provide positive customer service to external customers, including customers who may be demanding or otherwise challenging.

+ Must be comfortable calling members, providers, and pharmacies.

+ Excellent communication, organizational and customer service skills.

+ Knowledge of basic medical terminology and concepts used in care management.

+ Knowledge of standardized processes and procedures for evaluating medical support operations business practices.

+ Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.

+ Ability to pay attention to the minute details of a project or task.

+ Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.

+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.

Salary Range: $38,520 - $70,620

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Stars

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

\#LI-NH2

REQNUMBER: 21600