Company :Highmark Inc.Job Description : 

JOB SUMMARY

The job plays a critical role in the clinical team, acting as the primary support for the clinical staff and as a liaison between all members of the care team.  Works in tandem with the case managers and disease managers to help facilitate execution of case and disease management, including not limited to, tracking necessary information for member's case, interacting with the member's provider, enabling nurses to optimize workload, helping to arrange required services for the member, assisting with documentation. This job will collaborate and require frequent communication with other members of the team.

ESSENTIAL RESPONSIBILITIES

Screen care management cases (condition management, disease management, etc.) to ensure information is complete and accurate (e.g. identify phone number if missing) and help prioritize cases for outreach; will triage cases to the appropriate person.Interact with providers to monitor members discharge status disposition, to confirm member activity, to set up appointments, and other provider related activities.  Provide assistance to the case manager in monitoring member outcomes as a result of engagement in care management.Identify and effectively utilize health plan benefits and local provider / community resources to help meet the needs of members; develop expertise about available community resources in assigned geography and share knowledge across the team.Assist in report production, data collection and data entry for care plan management; perform process auditing activities to ensure compliance with NCQA standards and other compliance measures.Research information about members such as clinical history, utilization patterns, benefits, etc., and present information to the case manager and other care team members; help with documentation of member interventions.Arrange required services for the member; perform other condition and case management support activities as assigned, including member telephonic contact as appropriate per business unit needs.Act as the liaison among all the members of the care team and promote collaborative teamwork.Other duties as assigned or requested.

REQUIRED EDUCATION

High School Diploma/GED

Substitutions

None

PREFERRED EDUCATION

None

EXPERIENCE

Required

3 - 5 years' performing administrative support functions in an office or field setting for a healthcare organizationExperience utilizing customer service related skills

Preferred

Experience in a health care related customer service or marketing environment that would demonstrate the ability to positively impact the engagement of members in the Organization's condition and case management programBasic knowledge of care management processes

SKILLS

Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms and other office proceduresAbility to take direction, to navigate through multiple systems simultaneouslyAbility to communicate, interact, and work effectively and cooperatively with all levels of staff and management teamsAbility to handle many tasks simultaneously and respond to customers and their issues promptlyAbility to communicate well in person, via phone and via e-mail (verbally and written)Proficient computer skills, including MS Office products

LICENCES OR RESPONSIBILITIES

Required

None

Preferred

None

LANGUAGE REQUIREMENT (other than English)?  
None

TRAVEL REQUIREMENT:

0% - 25%

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
 

Position Type:

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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