Managed Care Coordinator I, Behavioral Health

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

📋 Description

• Conducts assessments of service requests to ensure all necessary information is complete, collects and transfers non-clinical data, and obtains structured clinical data from physicians and patients.

• Prepares, documents, and routes cases through the appropriate systems for clinical evaluation.

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

• Reviews issues related to professional medical claims or policies for claims that are pending.

• Serves as a communication link between providers, members, and Care Managers.

• Authorizes services based on established scripts or algorithms for pre-review screening when applicable.

• Conducts initial screenings for pre-certification requests under the guidance of clinical staff.

• Assists members in locating providers, resolving issues, and addressing inquiries regarding services and appeals.

• Makes outbound calls to involve members in Case Management and complete necessary health assessments.

• Educates members on preventive health activities and available services.

• Aids members with scheduling appointments, arranging transportation, changing primary care physicians, updating demographic information, and issuing new ID cards.

• Triages and distributes referrals and provider faxes efficiently.

• Reviews medical, dental, and vision claims, addressing gaps in preventive care.

• Assesses medical and administrative documents for accuracy, grammar, and compliance with regulations.

• Conducts initial screenings of determination letters prior to their distribution.

• Makes informed, timely decisions under the supervision of a designated Supervisor.

• Performs additional related tasks as assigned by Management.

⛳️ Requirements

• High School Diploma or GED is required.

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

• Must possess knowledge of medical terminology.

• Preferred experience in Medicaid Case Management.

• Requires strong oral and written communication skills.

• Must be capable of making sound decisions under the guidance of a Supervisor.

• Preferably knowledgeable about contracts, enrollment, billing, and claims coding/processing.

• Preferred understanding of Managed Care principles.

• Prefer the capability to analyze and resolve issues with minimal supervision.

• Prefer proficiency in using personal computers and relevant software and systems.

• Must be a team player with strong analytical and interpersonal skills.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous Paid Time Off

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement