Care Guide

Our Healthcare Operations team is seeking a Care Guide who can help members identify medical and socio-economic issues that affect their overall health. Work with members through the duration of their health journey. Develop and support a health/social care plan to include goals.

We are looking for a Care Guide with:

Experience: 2 years' relevant

Education: Associate degree in Nursing or Bachelor's Degree in Social Work; or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)

Licenses/Certifications: Must hold one of the following:

• Valid unrestricted Idaho Registered Nursing License
• Valid unrestricted Idaho Social Worker License

Preferred qualification:

LMSW

What your day may look like:

• Communicates to members the purpose of the program and the benefits of engaging with the Care Guide.
• Conducts assessments of the members' current status and develops a care plan with the members to address member's goals while considering member's strengths and barriers.
• Performs comprehensive tracking of members compliance in relation to care plan objectives as measured against short and long-term goals.
• Facilitates coordination of care with providers. Motivates members to be active and engaged participants in their health and overall well-being.
• Participates in case rounds with Medical Director and other healthcare operations staff in order to facilitate appropriate levels of care and services.
• Collaborates with internal partners and providers in order to achieve the most appropriate outcome while promoting the most cost-effective use of available resources.
• Tracks and reports cost savings throughout the duration of the individual's membership.
• Helps members review benefit concerns and connect with appropriate internal resources to expedite resolution of concerns and inquires.
• Provides support and advocacy during medical care of when necessary, to assure members medical needs and referrals required are being conveyed. Identifies and assists with care coordination related to gaps in care.
• Completes medical review of select requested services.
• Performs other duties and responsibilities as assigned.

As of the date of this posting, a good faith estimate of the current pay range is 76,346

to 114,518. The position is eligible for an annual incentive bonus (variable depending on company and employee performance.

The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.