Managed Care Coordinator

2 weeks ago


Pennington, New Jersey, United States ICONMA Full time
:

Job Summary:

This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.


Responsibilities:

Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.

- Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.

- Prepare, document and route cases in appropriate system for clinical review. - Initiates call backs and correspondence to members and providers to coordinate and clarify benefits. - Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion. - Reviewing professional medical/claim policy related issues or claims in pending status.

- Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening.

Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information. - Perform other relevant tasks as assigned by Management.

Core Individual Contributor Competencies:

Personal and professional attributes that are critical to successful performance for Individual

Contributors:

Customer Focus Accountable Learn Communicate

Qualifications:


Education:

High School Diploma required. Some College preferred.

Work experience:

Prefer 1-2 years customer service or medical support related position.

Specialized knowledge/skills:

Requires knowledge of medical terminology - Requires Good Oral and Written Communication skills - Requires ability to make sound decisions under the direction of Supervisor - Prefer knowledge of contracts, enrollment, billing & claims coding/processing - Prefer knowledge Managed Care principles - Prefer the ability to analyze and resolve problems with minimal supervision - Prefer the ability to use a personal computer and applicable software and systems - Team Player, Strong Analytical, Interpersonal Skills

Additional Skills:

Prior Healthcare exp preferred.


As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.



  • Pennington, New Jersey, United States Bank of America Full time

    Job Title: Product Manager - Institutional Retirement at Bank of AmericaBank of America is on a mission to enhance financial well-being by fostering strong connections. Operating under the values of Responsible Growth, the company strives to serve its clients, employees, communities, and shareholders effectively every day.Central to achieving Responsible...


  • Pennington, New Jersey, United States Capital Health Services Full time

    Work Shift: Capital Health is a top provider of quality patient care in the region, with a strong focus on investing in outstanding physicians, nurses, and staff, as well as cutting-edge technology innovation. Recognized five times as a Magnet-Recognized health system for nursing excellence, Capital Health operates two hospitals. The Capital Health...


  • Pennington, New Jersey, United States Capital Health Services Full time

    Work Shift:Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made...


  • Pennington, New Jersey, United States Capital Health Services Full time

    Work Shift:Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made...


  • Pennington, New Jersey, United States Capital Health Full time

    The trauma fellowship trained orthopedic surgeon provides surgical and non-surgical care to complex orthopedic trauma patients including those with pelvic fractures, complex, intra-articular fractures, bone defect surgery, treatment of osteomyelitis, non-unions and other complex pathologies requiring advanced knowledge and skill. The individual will provide...

  • Clinical Pharmacist

    2 weeks ago


    Pennington, New Jersey, United States Integrated Resources, Inc Full time

    Job Description: This position serves as internal and outward-facing, dedicated clinical resource responsible for quality measures supporting the pharmacy department in identifying Star/HEDIS measure needs and expectations, and developing and managing initiatives to achieve 5 stars. The position has oversight responsibilities driven by metrics to manage...


  • Pennington, New Jersey, United States HDR Full time

    About Us At HDR, we specialize in engineering, architecture, environmental and construction services. While we are most well-known for adding beauty and structure to communities through high-performance buildings and smart infrastructure, we provide much more than that. We create an unshakable foundation for progress because our multidisciplinary teams also...

  • Med Assistant II

    2 weeks ago


    Pennington, New Jersey, United States Capital Health Full time

    Work Shift:Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made...

  • Electrical Engineer

    2 weeks ago


    Pennington, New Jersey, United States HDR Full time

    About UsAt HDR, we specialize in engineering, architecture, environmental and construction services. While we are most well-known for adding beauty and structure to communities through high-performance buildings and smart infrastructure, we provide much more than that. We create an unshakable foundation for progress because our multidisciplinary teams also...

  • Risk Analyst

    2 weeks ago


    Pennington, New Jersey, United States Experis Full time

    ManpowerGroup has partnered with a leading Banking Services organization in Pennington, NJ/Plano, TX/Richmond, VA (Hybrid) for a Risk Analyst to assist their team.I will attach the job description and details. Do let me know if you're interested. As it is a fast-moving requirement, I expect your response soon.Title: Risk AnalystLocation: Pennington,...


  • Pennington, New Jersey, United States Syntricate Technologies Inc Full time

    Hi,We are looking for an Oracle PL/SQL Developer. Please let me know, if interested.Oracle PL/SQL DeveloperPennington, NJ (Onsite-Hybrid)Full-TimeJob description: Candidate with strong Data Analytical skills (for data stored in Oracle / SQL Server). Job requires interactions with onsite leadership/developer and strong technical background. Experienced...


  • Pennington, New Jersey, United States Infosys Full time

    Job Description Infosys is seeking an Lead Oracle PL/SQL Developer. This position's primary responsibility will be to provide technical expertise and coordinate for day to day deliverables for the team. The chosen candidate will assist in the technical design of large business systems; builds applications, interfaces between applications, understands data...


  • Pennington, New Jersey, United States Genie Healthcare Full time

    Genie Healthcare is seeking a travel Physical Therapist for a travel job in Pennington, New Jersey. Job Description & RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: 06/24/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelOutpatient PT - Pelvic Floor/Womans Health experinceMonday through Friday,...


  • Pennington, New Jersey, United States Capital Health Full time

    General Psychiatrist needed at Capital Health Department of PsychiatryLocation: 100 K Johnson Blvd., Bordentown, NJ 08505Employment: Part-time (FTE - .5)Call: All physicians handle call for their patientsCapital Health Behavioral Health Specialists is looking for a Board Certified/Board Eligible General Psychiatrist to join their team. They focus on the...


  • Pennington, New Jersey, United States Capital Health Full time

    Work Shift:Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made...

  • Preschool Teachers

    2 weeks ago


    Pennington, New Jersey, United States The Learning Experience Full time

    At The Learning Experience, our team of Preschool Teachers play a crucial role in creating a positive impact on the lives of children, families, and communities every single day. College students and retired teachers are encouraged to submit their application.Co Lead Preschool Teacher - for age groups 3 to 4Co Lead Toddler Teachers - for age groups 1 to 2The...


  • Pennington, United States Winston Medical Staffing Full time

    Job DescriptionJob Description3 Immediate hybrid roles for top NJ Employer, 830 to 500pm weekdays This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Performs review of service requests for completeness of...


  • Pennington, United States Winston Medical Staffing Full time

    Job DescriptionJob Description3 Immediate hybrid roles for top NJ Employer, 830 to 500pm weekdays This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Performs review of service requests for completeness of...


  • Pennington, United States The Jacobson Group Full time

    Job DescriptionJob DescriptionJob Summary: This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.Responsibilities: - Performs review of service requests for completeness of information, collection and transfer...


  • Pennington, United States The Jacobson Group Full time

    Job DescriptionJob DescriptionJob Summary: This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.Responsibilities: - Performs review of service requests for completeness of information, collection and transfer...


  • Pennington, United States Northpointe Staffing Professionals Full time

    Job DescriptionJob DescriptionThis position will be fully onsite for training and then will be a hybrid work schedule.Work Hours - . Monday-Friday 8:30-5:00This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service...


  • Pennington, United States Capital Health Full time

    Work Shift: Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is...


  • Pennington, United States Capital Health Full time

    Work Shift: Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is...


  • Pennington, United States ShopRite Full time

    The Catering Coordinator is a Non-Affiliated Associate who is a main point of contact for receiving and recording all catering orders that are placed in person, on the phone or online. The Catering Coordinator must consistently be personable and a ro Catering, Coordinator, Department Manager, Hospitality, Operations, Dance, Restaurant, Grocery


  • Pennington, United States ShopRite Full time

    ShopRite - ShopRite of Pennington [Restaurant Server / Team Member] As a Catering Coordinator at ShopRite, you'll: Manage the flow of catering orders - from the Customer and production side of the business; Maintain communication with Department Managers regarding orders/changes or any issues in a timely manner; Coordinate, schedule and communicate all...

  • RN MDS Coordinator

    1 month ago


    Pennington, United States Epic Healthcare Full time

    Epic Healthcare - Now Hiring: MDS Coordinator We are currently seeking a dedicated and experienced MDS Coordinator to join our team in New Jersey. As an integral member of our healthcare team, you will play a crucial role in ensuring accurate and comprehensive assessments for our residents.   Why work for us as an MDS Coordinator?  Competitive...


  • Pennington, United States Capital Health Services Full time

    Work Shift: Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made...


  • Pennington, Alabama, United States Collabera Full time

    Position Details:Client: Banking and FinancialRole: UAT Project Coordinator (Junior)Project Location: Pennington, NJ (Onsite) Project Duration: 4+ MonthsPay Range: $34/hour to $39/hourJob Description: Join the Client Data & Project Delivery team to support Wealth Management's data strategy, focusing on gathering, storing, and maintaining client data. Manage...


  • Pennington, United States Collabera Full time

    Position Details: Client: Banking and Financial Role: UAT Project Coordinator (Junior) Project Location: Pennington, NJ (Onsite) Project Duration: 4+ Months Pay Range: $34/hour to $39/hour Job Description: Join the Client Data & Project Delivery team to support Wealth Management's data strategy, focusing on gathering, storing, and maintaining...

  • Marketing Coordinator

    2 weeks ago


    Pennington, United States Travefy Full time

    At Travefy we’re looking for a motivated pro to join our marketing team. YOU MUST APPLY ON OUR CAREER WEBSITE: - **Build tools that are shaping the future of travel.** At Travefy our mission is to power the success of travel professionals. Our platform - including trip proposal, itinerary management, and client management tools - help Travel Advisors,...

  • Project Manager

    1 month ago


    Pennington, United States Genesis10 Full time

    Genesis10 is currently seeking a Project Manager with our corporate investment banking company client in their Pennington, NJ location. This is a 6 month + contract position. Summary: Seeking a Project Manager. Responsibilities: Leads a wide array of activities associated with project planning and management to ensure that projects are completed on...

  • Project Manager

    4 weeks ago


    Pennington, United States Genesis10 Full time

    Genesis10 is currently seeking a Project Manager with our corporate investment banking company client in their Pennington, NJ location. This is a 6 month + contract position. Summary: Seeking a Project Manager. Responsibilities: Leads a wide array of activities associated with project planning and management to ensure that projects are completed on...

  • Rn Charge Nurse

    4 weeks ago


    Pennington, United States Complete Care at Park Place Center Full time

    **NOW HIRING: RN Charge Nurse** **UNDER NEW MANAGEMENT! APPLY FOR GREAT NEW PERKS!!!** **Join with a friend for an additional bonus!** **Complete Care at Park Place Center** **2 Deer Park Place** **Monmouth Township, NJ 08852** **716.325.1056** **Complete Care at Park Place Center **is a Long Term Care facility that provides quality care to our...

  • Receptionist

    4 weeks ago


    Pennington, United States Live Urgent Care Full time

    Job Type Full-time, Part-time Description Join Our Team at Live Urgent Care! Are you passionate about healthcare and committed to delivering top-notch patient care? Live Urgent Care, a state-of-the-art medical facility, is looking for dedicated professionals like you to join our dynamic team. With cutting-edge technology and a team of highly certified...

  • Radiology Manager

    1 month ago


    Pennington, United States Capital Health Full time

    Work Shift: Day (United States of America) Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals....

  • Radiology Manager

    4 weeks ago


    Pennington, United States Capital Health Full time

    Work Shift: Day (United States of America) Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals....