Manages member care and progress for cases with multiple levels of risk. Job Description: Job Responsibilities Supporting utilization management functions for more complex and non-routine cases as needed. Serving as a liaison between members, providers and
Investigates special investigation unit claims; analyzes and documents potential fraudulent insurance claims. Job Description: Job Responsibilities Preparing legal and investigation documentation; presenting findings and making recommendations to management. Participating in legal proceedings when necessary. Analyzing all
The position works alongside HCBS, discharge, and institutional care/support coordinators to promote interdependent collaboration with the member, physician/primary care manager, family, and other members of the care/support coordination team to ensure continuity of care by performing
Provides support of the population health quality improvement programs by engaging members, providers and the community in improving health outcomes. Job Description: Job Responsibilities Support the implementation of community-based population health activities ensuring that performance and
Manages member care and progress for cases with multiple levels of risk. Job Description: Job Responsibilities Supporting utilization management functions for more complex and non-routine cases as needed. Serving as a liaison between members, providers and
Support all product education, service and enrollment for all BCBST individual products (Medicare, Individual, and Ancillary). Job Description: Job Responsibilities Provide first contact resolution for member service inquiries at consumer centers including services such as benefit
Performs intake and enrollment assessments, person-centered planning, and ongoing maintenance and monitoring of overall service provision and each members well-being. Job Description: Job Responsibilities Partnering with members and families to identify needed supports and direct services