Florida Blue, FEP Quality LCSW,

Job Summary:
The FEP Quality LCSW is a member of the FEP Quality team that is directly responsible for the FEP Plan Incentive Program (PIP) scorecard and NCQA HEDIS Quality measures assigned to Florida Blue by FEP Directors Office and Office of Personnel Management (OPM). The goal of the Quality LCSW is to assist members with behavioral health conditions that trigger the identified FEP HEDIS measures to navigate and obtain appropriate follow up care to improve the members compliance and outcomes by closing HEDIS care gaps. The LCSW will help the member to reach their highest level of self-management, treatment, and success towards a healthier lifestyle. The LCSW works with internal and external partners on behavioral health clinical quality improvement initiatives related to FEP HEDIS. They will also conduct FEP member telephonic outreach to assist previously identified members in obtaining needed care in order to close specific FEP HEDIS care gaps. This may include speaking with the appropriate provider for the scheduling of an appointment, or other assistance as needed to close the FEP HEDIS care gaps. The candidate will collaborate with internal staff, analytics, care management, network, customer service and any area involved to define potential quality improvement activities.

Essential Functions:

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• Reviews FEP reports and professional claim reports for new behavioral health (BH) referrals (10%)
• Collaboration with internal as well as external stakeholders (10%)
• Engages members telephonically with a focus on identifying behavioral health open care gaps, educating members on opportunities for FEP initiatives, how to obtain follow up care, providing member education with a focus on self-management and adherence to medical treatment with the main goal to close HEDIS care gaps (25%)
• Counsels and educates members and their representatives using Behavioral Change Models (15%)
• Performs ongoing assessment and follow up of cases (15%)
• Educates providers, members, and community on the FEP Case Management (FEP CM), Care Coordination programs, Teladoc BH services, and serves as a resource (15%)
• Understands and maintains all compliance policies, regulatory standards and procedures, and contributes to Quality Improvement (QI) initiatives related to the FEP PIP scorecard (10%)

Required Work Experience:
4+ years related work experience. Experience Details: Behavioral health, substance abuse, NCQA HEDIS, managed care, and community healthcare
Related Master's degree or additional related equivalent work experience
LCSW - Licensed Medical Social Worker - State Licensure Current Florida Licensed Clinical Social Worker Upon Hire
Experience in both the Healthcare Industry and Managed Care Health Insurance Industry Proficient in Microsoft Office (Word, Excel, Outlook and PowerPoint)

Preferred Qualifications:
Experience with Claims process Bilingual Spanish/English

General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities:
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $69,400 - $112,800

Typical Annualized Hiring Range: $69,400 - $86,800

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.