About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have This position will work independently to navigate the health care system, identify where customer needs are, and match resources to help remove barriers to accessing care. The Care Management Navigator will work in collaboration with internal teams, members and providers to support run-the-business needs. This position provides advanced support to Care Management Operations leadership. The Navigator is a critical member of the Care Management team and is recognized by our customers as an advocate that supports our values. Your Responsibilities Maintain outstanding level of service at all points of customer contact. Maintain a strict standard of confidentiality to ensure that our members protected health information (PHI) is secure. Display compassion, respect, and self-confidence when conversing with customers. Research inquiries to ensure timely resolution of issues with minimal technical support. Represent members needs internally to account managers (e.g., Clinical Account Managers), clinicians and Health Support Coordinators within Care Management, Customer Services, and providers. Assist members and providers in obtaining needed information essential to the care management process. Engages with clinical team to address patient questions or concerns and transfer/refer members to a clinical resource when appropriate. Coordinates and collaborates as an important member of the care management team to enhance the overall operation of the division. Identify resource gaps internally or for the member, health plan and/or provider coverage needs. Provide feedback to leadership as necessary. Frontline Operations At the direction of Care Management Leaders, provide work direction to associates supporting the management of daily inventory and meeting the business needs. Perform quality audits on non-clinical staff to ensure process comprehension, accuracy, and efficiency related to process. Provide feedback to leadership as necessary. Deliver supplemental onboarding and on-the-job training for identified intake staff. Including but not limited to: Online training modules, job aid support, and training plans. Manage, monitor, and update role-specific reports. Take appropriate actions based on reporting outputs. Serve as a system expert for UAT testing, and/or enhancement implementation for new system processes. Provide day to day support for associates, act as primary resource to for associates to support process and issue resolution. Analyzes, develops, and works in partnership with leadership to develop and implement workflow and procedure changes Intake requests from claims and appeals teams. Research and respond to requests to ensure adequate claims processing. Utilization Management (UM) At the direction of Care Management Leaders, provide work direction to associates supporting the management of daily inventory and meeting the business needs. Perform quality audits on non-clinical staff to ensure process comprehension, accuracy, and efficiency related to process. Provide feedback to leadership as necessary. Deliver supplemental onboarding and on-the-job training for identified intake staff. Including but not limited to: Online training modules, job aid support, and training plans. Monitor, manage and complete tasks related to the distribution of inventory or intake tasks. Including but not limited to data entry, work queues, and direct phone calls. Manage, monitor, and update role-specific reports. Take appropriate actions based on reporting outputs. Serve as a system expert for UAT testing, and/or enhancement implementation for new system processes. Process Out of Network, Transition of Care, Continuity of Care, select DME, Rate Negotiations, and J-Flag requests in collaboration with Care Management Clinical Teams and the use of medical policies. Provide day to day support for associates, act as primary resource to for associates to support process and issue resolution. Intake requests from claims and appeals teams. Research and respond to requests to ensure adequate claims processing. Case Management (CM) Works with members across care episodes and throughout the continuum of care (e.g., financial, medical, behavioral, etc.). Independently assess member's needs, gather accurate and comprehensive member information, and research resources and assistance programs that may be available to members in multiple states and across all lines of business. Match these resources as appropriate to support needs of members. Conducts outreach to and engages members in case management programs. Works with member through the program duration and assist with non-clinical care plan goals. Proactively provide information and education to customers, as appropriate, about a variety of health, financial, and self-service programs. Serves as a member advocate by identifying underlying needs and facilitates referrals to external resources and services in the health care system, as appropriate. Required Skills and Experiences 3+ years of related experience. All relevant experience including work, education, transferable skills, and military experience will be considered. General understanding of medical terminology, health insurance, and social determinants of health Ability to quickly gain customer trust and confidence. Demonstrated skills as an empathetic and compassionate communicator. Outstanding communication and customer service skills. Outstanding analytical thinking skills. Outstanding task facilitation skills. Strong computer application skills. Accurate record-keeping abilities. Demonstrate leadership ability. Consistently meet all performance measures. Demonstrated ability to enhance or develop new skills in response to changing expectations. Strong problem solving and decision-making skills. Self-motivated, capable of working independently as well as cooperatively in a team setting. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experiences Background in healthcare or related field. Strong independent research capabilities. Experience with medical terminology or coding. Demonstrated ability to work across functional areas within the organization. Compensation and Benefits: Pay Range: $26.57 - $33.21 - $39.85 Hourly Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We offer a comprehensive benefits package which may include: Medical, dental, and vision insurance Life insurance 401k Paid Time Off (PTO) Volunteer Paid Time Off (VPTO) And more To discover more about what we have to offer, please review our benefits page. Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
