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Managed Care Coordinator I
2 months ago
This position involves working Monday through Friday from 8:30 AM to 5:00 PM in a remote capacity. Candidates will participate in a Teams interview with two members of the department, followed by a week of onsite training.
Key Qualifications:- Proficiency in computer usage and typing is essential, as multiple software applications are utilized in this role.
- Desired attributes include attention to detail, effective communication skills, time management, organizational abilities, teamwork, and the capacity to work independently.
A typical day includes logging onto the computer at 8:30 AM to assess the workload and prioritize tasks. Incoming faxes and phone requests will be managed, focusing on service dates or deadlines to determine case priorities. Requests will be reviewed against policy guidelines and member contracts, and clinical reviews will be conducted to ascertain if they can be processed at our level. If necessary, cases will be escalated to the medical director for further review. The role involves completing approvals or denials and notifying the relevant providers.
Communication:Strong communication skills are crucial as this role involves interaction with both members and providers.
Team Dynamics:Our approach emphasizes teamwork, with collaboration aimed at achieving our objectives and delivering exceptional services to our members. The team consists of 12 nursing professionals, and we value team-building activities to foster relationships among team members. We seek candidates who resonate with our team culture.
Responsibilities:- Evaluate medical or behavioral eligibility concerning benefits and clinical criteria by applying clinical expertise and administrative policies to service requests.
- Utilize clinical knowledge and claims analysis to assess, plan, implement, and monitor care plans, ensuring compliance with medical necessity and benefit guidelines.
- Document clinical information accurately to support medical necessity and benefit determinations.
- Identify and refer cases to appropriate staff members as needed, ensuring compliance with relevant legislation and guidelines.
- Engage in direct intervention and patient education, advocating for members through ongoing communication and education.
- A minimum of 2 years of clinical experience is required.
- Proficient in word processing software, with the ability to work independently and prioritize effectively.
- Strong judgment, customer service, organizational, and presentation skills are necessary.
- Excellent oral and written communication skills, with the ability to persuade and influence others.
- Analytical thinking and discretion in handling confidential information are essential.
- An Associate Degree in Nursing or graduation from an accredited nursing program, or a Master's degree in Social Work, Psychology, or Counseling is required.
US Tech Solutions is a global staffing firm that provides a diverse range of talent on-demand and comprehensive workforce solutions. For more information about US Tech Solutions, please visit our website.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
