Care Coordinator – Central DD

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

📋 Description

• Supervise and facilitate the coordination of managed care services, which includes verifying eligibility, managing referrals, and obtaining authorizations for medical procedures, treatments, and services.

• Provide tailored health education and coaching to members based on the concerns identified in treatment and service plans.

• Assist members in addressing social determinants of health by facilitating access to exercise opportunities and nutritious food.

• Verify insurance coverage and benefits for patients while maintaining accurate information.

• Conduct utilization reviews to assess the medical necessity and appropriateness of requested services.

• Collaborate with insurance companies and healthcare providers to ensure the availability and quality of services.

• Coordinate with a variety of healthcare providers for diagnostics, ambulatory care, and hospital services.

• Act as a point of contact for members, addressing questions, concerns, and complaints, while advocating for their needs.

• Promote health improvement initiatives, outreach efforts, quality improvement initiatives, and patient panel management.

• Manage community-based medication therapy.

• Ensure compliance with relevant laws, regulations, contractual obligations, and the PCSP.

• Maintain accurate and complete documentation of interactions, authorizations, and communications.

• Identify opportunities for process improvement and efficiency enhancement.

• Suggest and implement strategies to optimize service delivery and improve patient satisfaction.

• Collaborate with both external and internal stakeholders to ensure service efficiency.

⛳️ Requirements

• High School diploma with one (1) year of experience in the mental health field.

• Bachelor's degree in a relevant area such as healthcare, social work, psychology, or related social services field is preferred.

• Understanding of managed care principles, processes, and regulations.

• Familiarity with health insurance terminology, coverage, and benefit structures.

• Strong organizational skills with the capability to manage multiple tasks simultaneously.

• Excellent communication and interpersonal skills for effective collaboration with internal and external stakeholders.

• Detail-oriented with the ability to maintain accurate records and documentation.

• Proficient in utilizing computer systems and software applications pertinent to managed care operations.

• A valid driver's license and current automobile insurance that meets the state’s minimum requirement.

• Must be able to drive and conduct quarterly visits to members.

• Capable of prolonged periods of sitting at a desk and working on a computer.

• Ability to occasionally lift objects weighing up to 15 pounds.

🏝️ Benefits

• Fully remote work arrangement.

• Up to 25% travel percentage.

• Reasonable accommodations under the Americans with Disabilities Act (ADA), when medically and reasonably feasible.