Care Manager (Remote) ID-1330

PURPOSE:

Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.

This position will support the Maryland government programs division, specifically the Medicare Advantage line of business. The Care Manager helps members, families, and caregivers access the health care delivery system through outreach, education, follow-up, coordination support, and resources. You will work with other members of the interdisciplinary care team to coordinate services, decrease utilization, and ensure optimal health outcomes.

We are looking for an experienced professional to work remotely within the greater Baltimore/Washington metropolitan area. While this position is remote, the incumbent will be expected to come into a CareFirst location periodically for meetings, trainings and/or other business-related activities.

In addition, the Care Manager participates in community-based events, representing the face of CareFirst and its efforts to promote the health and wellness of our members and their communities.

ESSENTIAL FUNCTIONS:

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Licenses/Certifications Upon Hire Required:

  • RN - Registered Nurse - State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC.

Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.

Preferred Qualifications:

  • Bachelors degree in nursing.
  • CCM/ACM or other RN Board Certified certification in case management.
  • Previous experience with Medicare and/or Medicare Advantage patient populations with multiple co-morbidities, complex needs, social determinants of health and/or barriers to care.
  • Bilingual - fluent in Spanish.
  • Skilled in typing and working within various web-based platforms.

Knowledge, Skills and Abilities (KSAs)

  • Knowledge of clinical standards of care and disease processes.
  • Ability to produce accurate and comprehensive work products with minimal direction.
  • Ability to triage immediate member health and safety risks.
  • Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
  • Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
  • Knowledgeable of available community resources and programs.
  • Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint.
  • Ability to provide excellent internal and external customer service.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

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With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

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Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

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10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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