Care Coordinator, SW BH – Hope

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

📋 Description

• Supervise and facilitate managed care services, which include confirming eligibility, managing referrals, and securing authorizations for medical procedures, treatments, and services.

• Offer tailored health education and coaching to members based on specific issues highlighted in treatment and service plans.

• Assist members in navigating social determinants of health, such as access to exercise options and healthy food.

• Confirm insurance coverage and benefits for patients while documenting precise and current information.

• Perform 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 range of healthcare providers for diagnostics, outpatient care, and hospital services.

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

• Support outreach efforts, quality improvement initiatives, and management of patient panels.

• Oversee community-based management of medication therapy.

• Ensure adherence to relevant laws, regulations, contractual obligations, and the PCSP.

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

• Identify and implement process enhancements to optimize service delivery and enhance patient satisfaction.

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

⛳️ Requirements

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

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

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

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

• Strong organizational abilities to manage multiple tasks simultaneously.

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

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

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

• A valid driver's license and current automobile insurance that meets the minimum requirements in your state.

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

• Ability to spend prolonged periods sitting at a desk and working on a computer.

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

🏝️ Benefits

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

• Opportunities for personalized health education and coaching.

• Access to support for exercise opportunities and nutritious food.

• Up to 25% travel requirement.