Clinical Operations Specialist - 65325EB
WellPoint - Columbia, SC

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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. Position can be located anywhere in the USA - this position will be supporting work for South Carolina - must be able to work Eastern Time hours
        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. Position can be located anywhere in the USA - this position will be supporting work for South Carolina - must be able to work Eastern Time hours 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.

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        We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more...