Managed Care Coordinator

Job description:

We are looking for a Managed Care Coordinator to join our growing team. You will be offered a competitive hourly rate of $19.71- $21.13/ hour. We will also provide you a comprehensive benefits package.

As a Managed Care Coordinator you will support the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.

Responsibilities of the Managed Care Coordinator:

• 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
• Experience: