Job ID: J122791
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
This job is the primary clinician managing members wide range in health status/severity and clinical needs in either a case management or condition (disease) management program. The incumbent will be responsible for assessing health management needs of the assigned members and utilizing data/analytics present in FEP Direct Care Coordination Portal (HEDIS, pharmacy, appropriate site of service, high cost alerts, and member wellness profile to identify the member’s health-related conditions or serious medical issues.) The incumbent will be supported by an internal multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. The incumbent is responsible for interacting with external vendors (Nurse line, Rare Disease CM vendor), other Blue plans, and group – Blue Cross Blue Shield Association (BCBSA) Federal Employee Program Director’s applications and on occasions, the FEP DO Clinical Account Manager in care coordination.
5 - 7 years Clinical Services or 5 - 7 yearsCase Management to include 5 - 7 years Disease/Condition Management or 5 - 7 years Health Insurance Industry
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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