Care Coordinator

This is a fully remote position, open to applicants in California.

📋 Description

• Provide support to the care management team.

• Collaborate directly with Utilization Management Nurses on daily operations.

• Assist in monitoring and processing authorization requests.

• Document, update, and finalize referrals on a daily basis.

• Verify providers, member eligibility, benefits coverage, CPT/ICD-10 codes, dates, required fields, and supporting clinical data.

• Process referrals within the specified timeframes.

• Research information in the DOFR and EOC.

• Adhere to Coordinator guidelines for authorization requests.

• Coordinate, identify, and direct referrals that require review to Utilization Management Nurses.

• Aid with data entry, updates, and corrections.

• Engage with UM nurses and ensure timely follow-through.

• Handle incoming departmental calls.

• Communicate with providers, members, and health plans.

• Maintain compliance with PHI and HIPAA regulations.

• Proactively address and resolve issues.

• Attend meetings and complete necessary training sessions.

• Perform additional duties as required.

⛳️ Requirements

• Minimum of 2 years of experience in healthcare administration.

• At least 3 years of experience in customer service.

• HMO/Medical Group experience is preferred.

• Availability to work from 8 AM to 5 PM Pacific Standard Time.

• Bilingual proficiency is preferred.

• Proficiency in using Outlook, Microsoft Teams, Zoom, Microsoft Office, Word, Excel, and Adobe.

• Strong multitasking skills and ability to thrive in a fast-paced environment.

• Excellent problem-solving capabilities.

• Ability to maintain confidentiality in a highly sensitive environment.

• Strong written and verbal communication skills.

• Technologically savvy and exceptionally organized.

🏝️ Benefits

• 100% employer-funded medical coverage.

• 100% employer-funded vision coverage.

• 100% employer-funded dental coverage.

• 100% employer-funded life insurance coverage.

• Paid holidays.

• Paid sick leave.

• Paid vacation time.

• 401(k) retirement plan.

• Additional employee-funded coverage options.

• Flexible work environment and scheduling options.

• Opportunities for remote work.