Managed Care Coordinator I

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Assists Clinical Operations activities and serves as a point of contact among Members, Physicians, Delegates, Operational Business team members, and Member Service Coordinators.

• Conducts reviews of service requests to ensure all necessary information is complete and gathers non-clinical data.

• Initiates follow-up calls and correspondence with members and providers to coordinate and clarify benefits.

• Performs initial screening for pre-certification requests through calls or correspondence, adhering to established scripts and workflows.

• Aids members in locating providers, troubleshooting issues, and responding to inquiries about services.

• Makes proactive outbound calls to engage members in Case Management and to fulfill essential health assessments.

• Informs members about preventive health initiatives and available services.

• Reviews medical and administrative documentation to ensure accuracy and compliance with standards.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• Preferably 1-2 years of experience in customer service or a medical support role.

• Must possess knowledge of medical terminology.

• Requires strong oral and written communication skills.

• Ability to make sound decisions under the guidance of a Supervisor is essential.

• Prefer familiarity with contracts, enrollment, billing, and claims coding/processing.

• Knowledge of Managed Care principles is preferred.

• Ability to analyze and resolve issues with minimal supervision is advantageous.

• Proficiency in using a personal computer and relevant software and systems is preferred.

🏝️ Benefits

• Comprehensive health benefits including Medical, Dental, and Vision coverage.

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.