Care Management Specialist II

Premera Blue Cross; United States; Remote; USD 48,000 - 73,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

Pet insurance

Life and disability insurance

401K employer match

Pension plan

Wellness programs

Generous paid time off

Tuition assistance

Employee recognition program

On-site parking (where applicable)

On-site cafes and fitness center

Team engagement activities

Job summary

Premera Blue Cross is seeking a Care Management Specialist II to independently handle intake of inpatient and outpatient service requests, interacting with providers and facilities. This role requires commitment to a permanent weekend schedule (Saturdays and Sundays) after training.

Proficiency with Facets, Jiva, and Appian is expected. The position supports multiple lines of business and requires strong communication skills, time management, and ability to work both independently and in a team.

Qualifications

• High School Diploma or GED is required.
• At least 1 year of customer service experience is required.
• Health plan experience strongly preferred.
• Associate degree in medically related field preferred; experience with Premera systems preferred.

Responsibilities

• Process inpatient and outpatient service requests using Facets, Jiva, and Appian.
• Serve as a resource for customer service representatives and triage complex inquiries.
• Load and manage information for inpatient notifications and pre-service requests.
• Follow regulatory and accreditation standards relevant to the role.
• Collect data and perform initial case screening per clinical criteria.
• Handle specialized account needs and complex benefit requests.
• Assist in training and supporting new team members.

Skills

Customer service

Written & verbal communication

Microsoft Office

Education

High School Diploma or GED

Associate degree (Preferred)

Tools

Facets

Jiva

Appian

Job description

Workforce Classification:

Telecommuter

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

Premera is committed tobeinga workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development,we’reable to better serve our customers.It’sthis commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.

About the position of the Care Management Specialist II

The Care Management Specialist II works independently performing intake of inpatient and outpatient service requests and provides information to external customers and medical professionals as related to medical services inquiries. This Specialist is responsible for managing all lines of business. In this role you will work independently and apply your understanding of a variety of complex lines of business (e.g. national accounts, self-insured, fully-insured) when responding to both providers and facilities regarding their clinical review questions and requests. The Care Management Specialist II requires a permanent weekend schedule. The employee hired into this role will be scheduled to work both Saturdays and Sundays on a regular, ongoing basis with the ability to request PTO subject to availability. Candidates should apply only if they are able to commit to working both weekend days as part of your permanent schedule. This schedule would start after the training and ramp-up period.

What you’ll do:

• Applies knowledge of various applications within the Facets claims payment system and the Jiva Healthcare Management Platform (e.g. customer service, benefits, eligibility, prospective UM) in order to manage incoming inpatient and outpatient service requests via fax and electronic submission.
• Serves as a resource for the customer service representatives for medical inquiries that cannot be resolved by Operations; triages and consults with clinical staff as appropriate.
• Utilizes various applications (e.g. Facets, Jiva, and Appian) to process and load incoming information for inpatient notifications, discharges, pre-service requests, and outpatient services.
• Applies understanding of regulatory and accreditation standards related to the role.
• Follows clinical criteria as scripted, utilizing knowledge of medical terminology to collect data, conduct initial case screening and process requests. Review and collection of data does not require any clinical evaluation or clinical interpretation of information.
• Handles specialized account needs, and complex inpatient and outpatient account specific needs (e.g. customized benefit requests, overlapping coverage issues, special benefit handling).
• Identifies system and provider issues and trends; recommends changes to processes and takes lead in initiating improvements (e.g. team meeting discussions, creates job aides, initiation of procedure changes).
• Assists in training and supporting new team members

What you’ll bring:

• High School Diploma or GED (Required).
• One (1) year of experience in a customer service-oriented environment (Required).
• Prior Health Plan experience. (Strongly Preferred).
• Associate degree in medically related field (Preferred).One (1) year of experience with Premera systems and tools (Preferred).
• Demonstrated effective written and verbal skills with the ability to communicate professionally.
• Demonstrated effective telephone skills.
• Effective time management, organization and prioritization skills.
• Demonstrated ability to handle stressful situations, work in a high production environment and follow through on assigned tasks.
• Ability to work independently and as a member of a team and to work flexible hours to meet specific work demands.
• Intermediate skills with Microsoft Office Outlook, Word, Office Communicator, Live Meeting; familiarity with Excel.
• Basic knowledge of medical terminology.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they’re a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [e-mail] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city:

Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

National Salary Range:

$48,400.00 - $72,600.00

National Plus Salary Range:

$55,200.00 - $82,800.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.