Capital Blue Cross

Collaborate with members, family, healthcare providers, and community resources to coordinate services and address barriers, guiding members to achieve optimal health, providing tools, information, and assistance to help them understand options and navigate the path to care. Responsibilities include identifying and securing access to needed healthcare, social services benefits, and community resources.

The Provider Service Representatives are the front-line team at Capital BlueCross responsible for handling all provider inquiries through multiple channels. The incumbent will be responsible for effectively presenting and discussing our products and services, creating and maintaining positive relationships, and exceeding quality, productivity, and ultimate performance goals. This incumbent will be required to initially attend a training class.

Support the financial performance and strategic business insights for Medicare Advantage, ACA, and CHIP lines of business. Provide data-driven insights, financial planning, performance optimization strategies, and regulatory alignment to senior leadership. Support financial strategy, forecasting, and performance oversight for Medicare Advantage and ACA portfolios.

The Salesforce Technology Specialist I will design, develop, test, document, and deploy highly technical and complex Salesforce solutions. They will collaborate with the Salesforce Delivery Teams and Application Architecture team on integrations and solution deployment. The specialist will enhance subject matter expert level knowledge and stay well-informed about best practices and new functionality on the Salesforce platform as well as Apttus Configure Price Quote (CPQ) solutions.

This role, part of the Utilization Management department, processes acute and post-acute inpatient and select outpatient higher level of care requests through clinical review and approved medical necessity criteria. Collaboration within and across departments and operating professionally and efficiently is essential.

The Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes. The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome.