Managed Care Coordinator
2 months ago
Description: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 CommunicateQualifications: 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 terminologyRequires Good Oral and Written Communication skillsRequires ability to make sound decisions under the direction of SupervisorPrefer knowledge of contracts, enrollment, billing & claims coding/processingPrefer knowledge Managed Care principlesPrefer the ability to analyze and resolve problems with minimal supervisionPrefer the ability to use a personal computer and applicable software and systemsTeam Player, Strong Analytical, Interpersonal SkillsHedis ProjectAs 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.
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Clinical Case Manager
2 weeks ago
Newark, New Jersey, United States Christiana Care Full timeJob SummaryChristianaCare is seeking a skilled Clinical Case Manager to play a critical role in ensuring the delivery of efficient and effective healthcare services. As a Registered Nurse, you will conduct admission and concurrent reviews to evaluate medical necessity and appropriateness of care. You will collaborate with healthcare providers to develop and...
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Care Coordination Manager
6 days ago
Newark, Ohio, United States I Am Boundless Full timeAbout the Role:We are seeking a highly skilled Care Coordination Manager to join our team at I Am Boundless. As a key member of our organization, you will be responsible for supervising and managing Care Coordination staff, providing care coordination and behavioral health services for OhioRISE.Key Responsibilities:Supervise and manage Care Coordination...
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Clinical Care Coordinator
1 week ago
Newark, Delaware, United States Christiana Care Full timeJob Summary:We are seeking a skilled Discharge Planning Specialist to join our team at Christiana Care. As a key member of our care management team, you will be responsible for coordinating patient care and driving patient progression to establish a discharge plan.About the Role:The Discharge Planning Specialist will work closely with an interdisciplinary...
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Care Management Supervisor
4 weeks ago
Newark, Delaware, United States Christiana Care Full timeCare Management SupervisorJob Summary:We are seeking a highly skilled Care Management Supervisor to join our team at Christiana Care. The successful candidate will provide direct care management services to a defined patient population, while providing supervisory services to the Case Management & Social Work staff.Key Responsibilities:Maintain assignment...
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Program Coordinator
6 days ago
Newark, Ohio, United States I Am Boundless Full timeCare Management Program OverviewAt I Am Boundless, we are committed to providing exceptional care management services to individuals and families. As a Program Coordinator, you will play a vital role in coordinating referrals, managing reporting, and recording transitions of levels of care within our Care Management program. Key ResponsibilitiesCoordinate...
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Patient Care Manager
2 weeks ago
Newark, Delaware, United States Stanford Health Care Full timeJob SummaryWe are seeking a highly skilled and experienced Patient Care Manager to join our team at Stanford Health Care. As a Patient Care Manager, you will be responsible for overseeing the daily operations of our patient care units, ensuring that patients receive high-quality, compassionate care. You will work closely with our nursing staff, physicians,...
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Care Coordinator
2 weeks ago
Newark, Delaware, United States Global Force Full timeCare Coordinator Job DescriptionAt Global Force, we are seeking a highly skilled Care Coordinator to join our team. As a Care Coordinator, you will play a critical role in supporting the development of and executing on the outreach strategy in a certain territory for the purposes of influencing health outcomes and member engagement.Key...
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Care Management Supervisor
1 week ago
Newark, Delaware, United States Christiana Care Full timeJob Title: Care Management SupervisorJob Specialty: Behavioral Health - Social Worker-ClinicalJob Duration: Full TimeShift: DaysGuaranteed Hours: Not specifiedExperience: Minimum 5 years in a healthcare environment, at least 2 years in a leadership roleLicense: Licensed Social Work credential required by June 11, 2024, State of Delaware; If RN, licensed to...
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Research Nurse Coordinator
4 weeks ago
Newark, Delaware, United States Christiana Care Full timeJob Title: Research Nurse CoordinatorWe are seeking a highly skilled Research Nurse Coordinator to join our team at the Helen F. Graham Cancer Center & Research Institute in Newark, DE.About the Role:The Research Nurse Coordinator will be responsible for screening, enrolling, planning, implementing, and evaluating protocol-related care of participants and...
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Care Coordinator
2 weeks ago
Newark, United States I Am Boundless Full timeSalaryFull-Time/Part-Time Full-Time Shift First Location Newark, OH Position Care Coordinator - CME Category Care Management Exempt/Non-Exempt Exempt Open Date 10/15/2024 Close Date 11/15/2024 Req Number CAR-24-00028 Description Are you a Care Coordinator who is passionate about people? Are you looking for a job where you'll enjoy excellent benefits and the...
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Care Coordinator Specialist
2 weeks ago
Newark, Delaware, United States Global Force Full timeCare Coordinator Job DescriptionGlobal Force is seeking a highly motivated and detail-oriented Care Coordinator to join our team. As a Care Coordinator, you will play a critical role in supporting the development and execution of outreach strategies to influence health outcomes and member engagement.Key Responsibilities:Assist providers in discharge planning...
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Resource/Care Coordinator
5 months ago
Newark, United States Global Force Full timeHourly Rate: 36.41/h As part of the care coordination team, the Resource Coordinator supports the development of and executes on the outreach strategy in a certain territory for the purposes of influencing health outcomes and member engagement. This position is responsible for establishing and cultivating relationships with members, community stakeholders...
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Patient Care Coordinator
6 days ago
Newark, Delaware, United States RWJBarnabas Health Full timeJob Title: Patient Care CoordinatorAt RWJBarnabas Health, we are seeking a highly skilled Patient Care Coordinator to join our team. This role will provide exceptional support to patients and families, ensuring seamless coordination of care and promoting optimal health outcomes.Key Responsibilities:Manage and maintain a caseload of clients, identifying those...
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Nurse Manager
2 months ago
Newark, Delaware, United States Christiana Care Full timeAbout the RoleWe are seeking a highly skilled and experienced Nurse Manager to join our Neuro Critical Care team at ChristianaCare. As a key member of our leadership team, you will be responsible for overseeing the clinical and administrative activities of our 18-bed Neuro Critical Care unit and our 6-bed Transitional Neuro unit.Key ResponsibilitiesSupervise...
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RN Case Manager
1 week ago
Newark, Delaware, United States LMHS Full timeJob SummaryThe RN Case Manager at Licking Memorial Health Systems is responsible for coordinating patient care across the continuum, ensuring high-quality, cost-effective outcomes. This role involves working with acutely ill and high-risk patients, developing individualized plans of care, and advocating for patients to make informed healthcare decisions.Key...
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Care Coordinator
2 weeks ago
Newark, United States I Am Boundless Full timeSalaryFull-Time/Part-Time Full-Time Shift First Location Newark, OH Position Care Coordinator - CME Category Care Management Exempt/Non-Exempt Exempt Open Date 10/15/2024 Close Date 11/15/2024 Req Number CAR-24-00028 Description Are you a Care Coordinator who is passionate about people? Are you looking for a job where you'll enjoy excellent benefits...
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Care Coordinator
7 days ago
Newark, United States I Am Boundless Full timeSalaryFull-Time/Part-Time Full-Time Shift First Location Newark, OH Position Care Coordinator - CME Category Care Management Exempt/Non-Exempt Exempt Open Date 10/15/2024 Close Date 11/15/2024 Req Number CAR-24-00028 Description Are you a Care Coordinator who is passionate about people? Are you looking for a job where you'll enjoy excellent benefits...
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Social Services Coordinator
2 weeks ago
Newark, Delaware, United States Christiana Care Full timeAbout the Role:We are seeking a compassionate and motivated Social Worker to join our team at ChristianaCare. As a Social Worker, you will play a critical role in resolving psycho-social barriers and supporting discharge needs for our patients.Key Responsibilities:Collaborate with our Care Management Triad Team to develop and implement discharge plans that...
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Case Management Coordinator
2 weeks ago
Newark, New Jersey, United States University Hospital, Newark NJ Full timeJob SummaryWe are seeking a highly skilled Case Management Coordinator to join our team at University Hospital in Newark, NJ. As a key member of our healthcare team, you will play a critical role in coordinating patient care and ensuring seamless transitions between healthcare settings.ResponsibilitiesCollaborate with physicians and clinical staff to develop...
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Medical Office Coordinator
2 weeks ago
Newark, Delaware, United States Christiana Care Full timeJob SummaryWe are seeking a highly organized and detail-oriented Medical Office Coordinator to join our Hematology Oncology team at Christiana Care. As a key member of our team, you will be responsible for providing exceptional patient care and administrative support to our physicians and staff.Key Responsibilities:Schedule appointments and manage patient...