Care Coordinator Specialist

3 weeks ago


Glenwood, Illinois, United States ChenMed Full time
About This Role

At ChenMed, we're transforming healthcare for seniors and changing America's healthcare for the better. We're a family-owned and physician-led organization that's rapidly expanding, and we need talented individuals to join our team.

Job Summary

We're seeking a highly skilled Care Coordinator Specialist to work with our Care Center of Excellence, Physician Management Resources (PMR), market leaders, external clients, and HMOs to establish, maintain, and support outpatient utilization management in PMR and delegated utilization management in ChenMed Medical Centers.

Key Responsibilities
  • Review approved and pended outpatient requests for PMR clients and ChenMed Markets on a daily basis.
  • Provide insights to the PMR team and Network Director, and work with them to take action.
  • Facilitate a daily process to help redirect poorly supported requests by:
    • Providing feedback to Humana, Careplus, Wellcare, and Coventry, and working through daily authorization requests when information is missing.
    • Creating a process for managing requests when patients need to see the primary care provider by coordinating with the primary care provider and Market leaders.
    • Enabling a member of the PMR network or clinical team to reach out to the authorization requester when deemed necessary.
  • Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent on market needs.
  • Travel as needed to PMR & ChenMed markets for training and support.
Requirements
  • Excellent analytical skills to solve complex and logistical problems.
  • Strong communication and interpersonal skills, both written and verbal, as well as delivery skills for presentations and training.
  • Excellent organizational skills with the ability to effectively manage multiple tasks and responsibilities.
  • Ability to deliver efficient, high-quality results within tight deadlines.
  • Works well independently and within a team.
  • Excellent influencing and negotiation skills.
  • Ability to explain complicated financial terms and utilization data to physicians/staff.
  • Ability to understand, interpret, and communicate all types of provider, regulatory contracts, and utilization management data.
  • Fluent in English.
Education and Experience
  • Bachelor's degree.
  • 3+ years of Utilization Management and/or Provider Relations or Healthcare Analyst experience or similar background.
  • Advanced MS Word and Excel.
  • The ability to establish credibility quickly and the willingness to take a strong approach to leadership.
  • An understanding of the communities that ChenMed and PMR serve, including the complexities of Medicare programs to patients in the current healthcare marketplace.


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