Care Management Support Specialist

Job Opportunity

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:

The Care Management Support Specialist coordinates the operational aspects of Care Management programming across multiple systems, enabling collaboration with internal teams and external partners to support member engagement and enrollment into Care Management services. Embedded within the Care Management department, this role supports efficient and effective digital and telephonic workflows that enable timely outreach, accurate routing, documentation completeness, and audit readiness, allowing licensed clinicians to focus on clinical assessment, care planning, and interventions. The Care Management Support Specialist partners closely with Care Management nurses, Quality and Community Health teams, and external vendor partners to manage referrals, support member onboarding into Care Management, resolve operational barriers, and ensure smooth day-to-day program operations. Through empathetic, member-centered coordination and strong cross-functional collaboration, the role contributes to a seamless member experience and the overall effectiveness of Care Management programs. The candidate for this position must reside in the Kansas City metropolitan area.

Job Description

• Coordinates Care Management programming by utilizing multiple systems and tools to support member engagement and enrollment across Care Management, Quality, and Community Health services
• Serves as a liaison between members, Care Management teams, and external vendor partners to facilitate timely handoffs, follow-up, and issue resolution
• Supports efficient and effective digital and telephonic engagement workflows, including referral routing, outreach coordination, task tracking, and documentation follow-up
• Proactively identifies operational issues, access barriers, or workflow gaps impacting member experience or program performance and escalates concerns to appropriate clinical or leadership partners
• Provides day-to-day operational support to Care Management programs, helping ensure workflows are organized, efficient, and consistently executed
• Maintains and updates standard operating procedures (SOPs), job aids, trackers, and workflow documentation to support consistency, quality, and audit readiness
• Compiles and maintains operational reports, dashboards, and tracking tools related to referrals, outreach activity, timeliness, and program performance
• Supports accreditation and regulatory readiness by maintaining required documentation, evidence logs, and trackers in partnership with designated accreditation leads (URAC, NCQA, and applicable state and federal requirements)
• Serves as a care management platform super-user, supporting testing, upgrades, enhancements, and surveys; documents issues and coordinates resolution with IT and business partners
• Partners with internal subject matter experts to support program launches, enhancements, and continuous improvement efforts as business needs evolve
• Maintains confidentiality of all regulated information in compliance with state and federal laws, including PHI and PII, and follows all corporate, divisional, and departmental policies and procedures
• Meets established individual and program performance standards, including productivity, quality, and service expectations
• Manages workload independently, handles multiple priorities simultaneously, and works with minimal supervision
• Performs other duties as assigned

Minimum Qualifications

• Associate degree in business administration, healthcare management, or a related field, or an equivalent combination of education and experience in healthcare operations, care coordination, health insurance, or a related support role
• 1–3 years of professional experience in healthcare operations, care coordination, health insurance, or a related support role
• Experience navigating multiple systems and tools to support members and internal teams across various communication channels
• Working knowledge of health insurance concepts, benefits, and healthcare navigation
• Strong organizational, communication, and problem-solving skills
• Proficiency with Microsoft Office applications

Preferred Qualifications

• Experience supporting Care Management, population health, quality, or community health programs
• Familiarity with URAC and/or NCQA accreditation standards and audit support activities
• Experience working in a matrixed or interdisciplinary environment
• Background in member advocacy, customer service, or program coordination within a healthcare or payer setting

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.