Care Coordinator, S Central DD – Hot Springs

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

📋 Description

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

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

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

• Confirm insurance coverage and benefits for patients, ensuring accurate and updated information is obtained and documented.

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

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

• Facilitate coordination with various 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 initiatives aimed at enhancing patient and community health, including outreach efforts, quality improvement initiatives, and patient panel management.

• Coordinate community-based management of medication therapy.

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

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

• Identify opportunities for process improvement and efficiency enhancement in managed care operations.

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

• Collaborate with both external and internal stakeholders to ensure the highest level of service efficiency.

⛳️ Requirements

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

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

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

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

• Strong organizational abilities with the capacity to manage multiple tasks simultaneously.

• Excellent communication and interpersonal skills to effectively collaborate with both internal and external stakeholders.

• Detail-oriented with the ability to maintain accurate 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 requirements in your state.

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

• Prolonged periods of sitting at a desk and working on a computer are required.

• The ability to occasionally lift objects weighing up to 15 pounds is necessary.

🏝️ Benefits

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