Managed Care Coordinator II, Bilingual – Spanish

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Provide support to Clinical Operations while serving as a point of contact among members, physicians, delegates, operational business personnel, and member service coordinators.

• Offer leadership and direction to the non-clinical team, addressing escalated issues and challenges.

• Evaluate service requests for thoroughness, gather and transfer non-clinical data, and obtain structured clinical information from physicians and patients.

• Prepare, document, and route cases for clinical assessment.

• Initiate callbacks and communication with members and providers to coordinate and confirm benefits and treatment plans.

• Gather and compile information necessary for addressing escalated phone and written inquiries.

• Investigate and resolve inquiries, then coordinate and confirm case completion with physicians and members.

• Assist in the onboarding and training of newly hired Managed Care Coordinators I and other Managed Care Coordinators.

• Serve as a liaison between providers, members, and Care Managers.

• Authorize services based on established scripts or algorithms for pre-review screening under clinical or supervisory oversight.

• Conduct initial screenings of precertification requests using defined scripts and workflows.

• Support members in locating providers, resolving issues, answering queries, filing appeals, and obtaining services.

• Engage members in Case Management and conduct health assessments.

• Distribute new case assignments to Case Management Clinical Staff.

• Review medical, dental, and vision claims and address any gaps in preventive care.

• Educate members on preventive health activities and available services.

• Assist members with scheduling appointments, transportation, changes to primary care providers, demographic updates, and issuance of new ID cards.

• Triage and distribute referrals and provider faxes.

• Ensure accuracy, grammar, and regulatory compliance in medical and administrative documentation.

• Review determination letters prior to distribution.

• Translate clinical and non-clinical documents between English and Spanish using accurate medical terminology.

• Make prompt decisions under the guidance of a supervisor.

⛳️ Requirements

• High School Diploma or GED is required.

• 3-5 years of experience in customer service is necessary.

• Medical certification translator education is required (Letters Team, Medically Certified Spanish Translator only).

• Knowledge of medical terminology is essential.

• Strong oral and written communication skills are required.

• Ability to make informed decisions under the supervision of a manager is necessary.

• Knowledge of clinical care standards and Star measures is required.

• Operational knowledge of healthcare delivery systems and the health insurance industry is essential.

• Appreciation for strategic planning is necessary.

• Familiarity with NCQA accreditation standards and applicable state and federal laws regarding health plan appeals and grievances is required (Letters Team, Medically Certified Spanish Translator).

• Understanding of CMS and state regulatory requirements is essential (Letters Team, Medically Certified Spanish Translator only).

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

• Will be required to work one holiday shift per year.

• Some travel may be necessary.

• Must review and translate documents in both English and Spanish.

• Preference for knowledge of contracts, enrollment, billing, and claims coding/processing.

• Preference for understanding Managed Care principles.

• Preference for the ability to analyze and resolve problems with minimal supervision.

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

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement