At Blue Cross and Blue Shield of Kansas City in Wichita, Kansas, United States.
Job Description
Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
- Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute.
- Annual incentive bonus plan based on company achievement of goals.
- Time away from work including paid holidays, paid time off and volunteer time off.
- Professional development courses, mentorship opportunities, and tuition reimbursement program.
- Paid parental leave and adoption leave with adoption financial assistance.
- Employee discount program.
Job Description Summary
Utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all member transplants. Acts as an internal and external customer resource for interpretation of transplant benefits and transplant-related claim adjudication. Serves as a company expert on current and future transplant types.
Responsibilities
- Completes member assessments by collecting and analyzing information across the seven domains of health and develops and implements individualized care plans with appropriate interventions in a culturally sensitive way.
- Monitors effectiveness of plan of care by gathering sufficient information from relevant sources in order to intervene, as appropriate, to improve health outcomes.
- Acts as liaison between member, employer, providers, support system and BlueCross BlueShield of Kansas City.
- Prioritizes interventions based on clinical need and readiness to change.
- Meets individual quality performance standards and annual targets for program performance as mutually agreed to by management team to maximize program value.
- Schedules time effectively and works with minimal supervision.
Additional Duties for Transplant Only
- Provides prior authorization of the transplant and manages individual member cases.
- Educates members, providers, and other customers regarding transplant benefits.
- Ensures proper payment of pre-transplant, transplant, and post-transplant claims.
At Blue Cross and Blue Shield of Kansas City (Blue KC), we know that success starts with a diverse workforce. Our ability to work effectively as individuals and collectively as teams is a direct reflection of our ongoing dedication. The Blue KC business philosophy is to leverage diversity and inclusion to meet the complex and ever-changing needs of our employees, partners and customers we serve. Blue KC is truly committed to fostering an inclusive culture through equal opportunity and respect. EOE/M/F/Vets/Disability
Affirmative Action Employer
Equal Opportunity Employer.
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