Member Care Coordinator

3 weeks ago

Roswell, United States PSG Global Solutions Careers Full time

Apply now and our proprietary system will quickly have you in front of a live recruiter.
The Opportunity
Description
We're looking for a Care Coordinator, working in Healthcare Systems and Services industry in Roswell, New Mexico, United States.

  • Responsible for home health assessments and system updates.
  • Perform outreach and follow up attempts to members on their health care plan.
  • Build relationships with members to encourage compliance with care plans and to alert the Case Manager quickly when issues arise.
  • Inform and educate members on their program, may use supplied scripts.
  • Complete records in system by performing data entry.
  • Encourage member usage of our programs, including arranging appointments and additional member services (e.g., transportation).
  • Generate appropriate correspondence and send to member manually, electronically, or telephonically.
  • Conduct check-ins with members to review individual care plan goals.
  • Maintain production requirements based on established department business needs.
  • Provide support to the clinical team by performing the non-clinical functions (as identified by the business process) necessary to generate, manage, and close a case within the platform.
  • Receive, analyze, conduct research and respond to telephone and/or written inquiries.
  • Process information from member or provider to determine needs/wants and ensure customer questions have been addressed.
  • Respond to customer or send to appropriate internal party.
  • Notify help desk of system issues.
  • Perform data entry function to update customer or provider information.
  • Obtain required or missing information via correspondence or telephone.
  • May serve as contact for the various groups regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from TMG, reopen or initiate new cases as needed and refer case to clinicians.
  • Support and maintain communications with various in-house areas regarding groups? concerns, i.e.: Marketing, Provider Affairs, and SSD.
  • Communicate and interact effectively and professionally with co-workers, management, customers, etc.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
  • Maintain complete confidentiality of company business.
  • Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Our Client

Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years' experience and growth.

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.

Big enough to have great opportunities. Small enough to care about finding the right one for you.

It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?

Experience Required for Your Success
  • Bachelor of Social Work or Psychology OR LVN, LPN with 1 year experience in managed care systems OR RN OR 3 years care coordination for a state managed or waiver program OR 3 years managed care systems experience.
  • Knowledge of medical terminology
  • Experience coordinating member medical related needs, providing assistance to members, and analyzing member needs
  • PC proficiency including Microsoft Office applications
  • Customer service skills
  • Verbal and written communications skills including developing written correspondence to members and to other department personnel and coaching skills, including motivational interviewing, to educate members on medical issues
  • Current state driver license, transportation, and applicable insurance
  • Ability and willingness to travel

What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?

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