Care Coordinator – Central DD

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

📋 Description

• Manage the coordination of managed care services by overseeing processes such as eligibility verification, referral management, and authorization procurement for medical procedures, treatments, and services.

• Provide tailored health education and coaching to members, addressing specific concerns outlined in their treatment and service plans.

• Assist members in accessing support related to social determinants of health, including connections to exercise opportunities and nutritious food options.

• Verify patients' insurance coverage and benefits, ensuring that accurate and current information is documented.

• Perform utilization reviews to assess the medical necessity and appropriateness of various services.

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

• Facilitate the coordination of various healthcare providers for diagnostics, ambulatory care, and hospital services.

• Advocate for members by serving as a point of contact to address questions, concerns, and complaints regarding managed care services, ensuring their needs are represented within the organization.

• Promote initiatives focused on enhancing the health of patients and their communities, including outreach activities, quality improvement projects, and management of patient panels.

• Coordinate community-based medication therapy management.

• Ensure compliance with relevant laws, regulations, and contractual obligations related to managed care services.

• Maintain thorough and accurate documentation of all interactions, authorizations, and communications.

• Identify opportunities for process enhancements and efficiency improvements within managed care operations, proposing and implementing strategies to optimize service delivery and boost patient satisfaction.

⛳️ Requirements

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

• A Bachelor's degree in a relevant field such as healthcare, social work, psychology, or other healthcare-related disciplines is preferred.

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

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

• Strong organizational skills with the capability to handle multiple tasks concurrently.

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

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

• Proficient in using computer systems and software applications relevant to managed care operations.

• A valid driver's license and up-to-date automobile insurance that meets the minimum state requirements.

🏝️ Benefits

• Health insurance

• Paid time off

• Flexible work arrangements