What you will do:
Must be flexible and have the ability work weekend and/or holiday hours when needed on a rotational basis.
a. Utilize critical thinking to recognize signs and symptoms of potential high-risk and complex conditions that warrant different or greater levels of support and proactively anticipate member needs in the navigation of the health care system and the benefits and resources available.
b. Discuss the care needs with the member through supportive, focused intervention methods and effective planning techniques.
c. Proactively identify barriers and gaps to care while designing, creating, and managing unique, individualized care plans that ensure members/providers have good communication channels, that members receive appropriate care, that potential duplication of services is avoided, and education is provided to help enable them to achieve the best possible health care goals.
d. Partner with members, members’ families, health care providers and community resources to coordinate and facilitate the care and services needed.
e. Actively engage members as participants in their unique care management plan and educate on their personal accountabilities and expected outcomes. Advise on included benefits and services that are appropriate for their current medical status, and how those benefits and services can positively impact not only their medical status, but also the total cost of care.
f. Stay curious and engaged by actively continuing to partner with other members of the Wellmark Team and research appropriate resources and/or programs as science and technology evolves, that may help to improve the health of assigned members going forward. Continue collaborative efforts with other clinical and nonclinical stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member and coordinate care. Facilitate additional referrals to providers, community resources/programs, and specific Wellmark programs, as necessary.
g. Using relevant technology tools, document care management activities accurately, consistently, and timely by following the standard work guidelines and policies to support internal and external processes. Comply with regulatory standards, accreditation standards and internal guidelines. Remain current and consistent with the specific standards pertinent to the Care Management team.
h. Other duties as assigned.
Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]
Please inform us if you meet the definition of a "Covered DoD official".