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Manager overseeing medical review processes for Medicare claims at BlueCross BlueShield of South Carolina. Ensuring compliance with standards and laws while driving continuous improvement in claim processing.
About the role
- Part-time Care Manager Float assisting LCI members navigating health systems. Coordinating care and support services to promote optimal health for frail elders and adults with disabilities.
Responsibilities
- Conduct a comprehensive assessment of the member's outcomes, needs and risks
- Coordinate care and benefits to ensure a comprehensive support approach
- Monitor and evaluate the members’ outcome-based member-centered plans
- Coordinate and participate in home visits and care conferences
- Implement risk mitigation strategies to promote the member’s health, safety and independence
- Create and maintain member records as required
- Maintain the confidentiality of member information and protected health information (PHI)
Requirements
- Certified Social Worker in the State of Wisconsin
- Minimum of one (1) year experience working with at least one of the Family Care target populations
- A four-year bachelor’s degree or more advanced degree in Human Services or related field with one (1) year experience working with at least one of the family care populations
- A four-year bachelor’s degree or more advanced degree in any other area than Human Services with a minimum of three (3) years’ experience working with at least one of the Family Care target populations
- Ability to be adaptable, prioritize and work in a fast-paced environment
- Working knowledge of computers, computer programs, typing, and data entry
- Ability to access members’ homes which are not required to comply with the ADA regulations
- Ability to lift up to 25lbs
- Current driver’s license, acceptable driving record and proof of adequate insurance
Benefits
- Health insurance
- Paid time off
- Flexible work arrangements
- Professional development
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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