Managed Care Coordinator

Our Client, a Health Insurance company, is looking for a Managed Care Coordinator for their Remote (NJ / NY / CT / MD / PA) location.

Responsibilities :

• This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.
• Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians / patients.
• Handles initial screening for pre-certification requests from physicians / members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
• Prepare, document and route cases in appropriate system for clinical review.
• Initiates call backs and correspondence to members and providers to coordinate and clarify benefits.
• Upon completion of inquiries initiate call back or correspondence to Physicians / Members to coordinate / clarify case completion.
• Reviewing professional medical / claim policy related issues or claims in pending status.
• Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening. Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information.
• Perform other relevant tasks as assigned by Management.

Requirements :

Why Should You Apply?