Care Coordinator, SW DD – Hope

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

📋 Description

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

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

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

• Confirm insurance coverage and benefits for patients, ensuring that accurate and current information is collected and documented.

• Conduct utilization reviews to assess the medical necessity and appropriateness of requested services, ensuring adherence to established guidelines and policies.

• Work collaboratively 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 primary contact for members, addressing their inquiries, concerns, and complaints regarding managed care services, and advocating for their needs within the organization.

• Promote initiatives to enhance the health of patients and their communities, including outreach efforts, quality improvement initiatives, and patient panel management.

• Coordinate community-based management of medication therapy.

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

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

• Ensure adherence to the PCSP and assist with resources needed or barriers to accessing treatment.

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

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

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

⛳️ Requirements

• High School diploma and 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 fields 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 concurrently.

• 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 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 requirement in your state.

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

• Ability to sit at a desk and work on a computer for extended periods.

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

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and growth.

• Supportive work environment with a focus on employee well-being.