Clinical Operations Specialist - 65256EB
WellPoint - Indianapolis, IN

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Anthem Blue Cross and Blue Shield is a proud member of the WellPoint family of companies. At Anthem, we are dedicated to improving the lives of the people we serve and the health of our communities. Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
        Responsible for coordinating non-clinical utilization/case management (UM/CM) activities and for collaborating with internal and external resources to support UM/CM efforts. Primary duties may include, but are not limited to: Collaborates with external community-based organizations to facilitate and coordinate care for children with special health care needs under the direction of an RN Case Manager. Assists Case manager in coordination of benefits with third party payers. For Medicare: May track members with Medicare coverable conditions for application, eligibility, and denial, and develop relationships with third party payers. For California Children Services: May request medical records from providers, may complete and submit CCS referral to local CCS program on same date of identification of potential CCS eligible condition. Tracks referral according to specified timelines and notifies providers and families of CCS eligibility determinations and referrals, BCC authorizations and/or deferrals. Maintains and updates tracking databases. Prepares UM/CM reports, documents all actions and provides administrative support for UM/CM. May provide quality control services. Anthem Blue Cross and Blue Shield is a proud member of the WellPoint family of companies. At Anthem, we are dedicated to improving the lives of the people we serve and the health of our communities. Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine. Responsible for coordinating non-clinical utilization/case management (UM/CM) activities and for collaborating with internal and external resources to support UM/CM efforts. Primary duties may include, but are not limited to: Collaborates with external community-based organizations to facilitate and coordinate care for children with special health care needs under the direction of an RN Case Manager. Assists Case manager in coordination of benefits with third party payers. For Medicare: May track members with Medicare coverable conditions for application, eligibility, and denial, and develop relationships with third party payers. For California Children Services: May request medical records from providers, may complete and submit CCS referral to local CCS program on same date of identification of potential CCS eligible condition. Tracks referral according to specified timelines and notifies providers and families of CCS eligibility determinations and referrals, BCC authorizations and/or deferrals. Maintains and updates tracking databases. Prepares UM/CM reports, documents all actions and provides administrative support for UM/CM. May provide quality control services.

        WellPoint - 18 months ago - save job - block
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        WellPoint, Inc. (WellPoint) is a health benefits company serving 35 million medical members, as of December 31, 2008. The Company is an...