Position Description:

Capital Blue Cross has an exciting opportunity for a Population Health Engagement Specialist to join our award-winning organization. Since 2014, Capital Blue Cross has scored higher than all health insurance providers publicly measured in the American Customer Satisfaction Index (ACSI) and is proud to be named a Best Places to work in PA, Harrisburg Magazine’s Simply the Best, and Highest Member Satisfaction J.D. Power Award.

The Population Health Engagement Specialist works under the guidance and direction of a Clinical Team Lead to provide clinical support to the Customer’s population. The Population Health Engagement Specialist is responsible for outreaching and engaging to assigned populations to support clinical education and coordination, including but not limited to: wellness, gaps in care and utilization. Based on a clinical algorithm and department protocols, the Population Health Engagement Specialist is responsible for identifying candidates who have complex or ongoing needs and appropriately referring them to other programs/resources.

Responsibilities and Qualifications:

• Acts as the point person within the Capital Blue Cross clinical area to collaborate with other departments within Capital Blue Cross and Customer to support the needs of their assigned population.
• Completes non-clinical surveys and education to assigned participants and engages them into programs, completes non-clinical interventions to meet member needs and identifies and refers candidates who require complex interventions to other programs/resources utilizing established criteria and documentation processes
• Completes program participant and provider communication activities as assigned, and documents all interventions in the participant’s record/documentation system in accordance with established policies and procedures.
• Identifies and reports potential quality of care issues as established and within the guidelines of intradepartmental processes. Complies with Capital Blue Cross and Customer’s policies and procedures. Identifies opportunities and proposes alternatives for improving the Population Management Programs. Prioritizes multiple tasks and assignments on a daily basis, seeks Team Lead guidance as appropriate.

Skills:

• Ability to operate a personal computer (PC), including proficiency in Word, Access, Excel and Outlook and Clinical Databases utilizing a talk and type method of documentation.
• Ability to interact with other departments, as needed, to advise, educate and/or direct members to appropriate services.
• Ability to apply critical thinking skills to daily activities.
• Demonstrates openness, flexibility, problem solving, patience, and tact when dealing with program participants, family and staff.
• Excellent written and oral communication skills.
• Ability to provide focus to Member/Family and redirect as needed.
• Excellent customer services skills and abilities that are demonstrated by prior work experience and references.
• Capable of working independently as well as part of a team.

Knowledge:

• Knowledge of NCQA standards for case management organizations, DMAA standards for disease management and CMSA Standards of Practice for Case Management, Act 68, NCQA, CMS and ERISA.
• Knowledge of managed care principles and emerging health treatment modalities.

Experience:

• Five (5) years’ experience working in an acute care hospital or other appropriate healthcare setting including responsibility for accurate data entry, efficient management of high volumes of phone calls or inquiries and demonstrated independent problem solving using pre-established guidelines and protocols

Education and Certifications:

• High School diploma required. Certified Medical Assistant preferred.

About Us: Capital Blue Cross is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. As a partner in the community’s health for over 80 years, Capital Blue Cross offers employees excellent pay, bonus opportunities, benefits, health and wellness incentives, opportunities for career advancement and community involvement, and work-life balance. In return, every member of our workforce plays an important part in something much bigger: working together and making a difference every day to improve the health and well-being of our members and the communities in which they live.