Care Coordination Specialist I

100 Horizon Healthcare Services, Inc; Hopewell (NJ); Vor Ort; USD 45.000 - 60.000; Vollzeit

Benefits dieser Stelle

Comprehensive health benefits (Medical

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Zusammenfassung

Horizon BCBSNJ in New Jersey is seeking a role that supports Clinical Operations and acts as a liaison between Members, Physicians, Delegates, and Care Managers.

You will review service requests, prepare cases for clinical review, and coordinate benefits with members and providers. The position emphasizes medical terminology knowledge, good communication, and the ability to work under supervision, with benefits and compensation aligned to the job level.

Qualifikationen

• Requires High School Diploma or GED.
• Prefer 1-2 years in customer service or medical support.
• Knowledge of medical terminology.
• Excellent oral and written communication.
• Ability to make sound decisions under supervision.

Aufgaben

• Review service requests for completeness and collect data.
• Prepare and route cases for clinical review.
• Coordinate and clarify benefits via calls and correspondence.
• Assist case management and provider/member inquiries.
• Initial screening for pre-certification requests.
• Refer to care managers and providers as needed.
• Educate members on preventive health activities.
• Assist with scheduling appointments and PCP referrals.
• Handle demographics changes and new ID cards.
• Review medical, dental, and vision claims to identify gaps.

Kenntnisse

Customer service

Medical terminology

Communication skills

Analytical skills

Team player

Ausbildung

High School Diploma/GED

Jobbeschreibung

Horizon BCBSNJ in New Jersey is seeking a role that supports Clinical Operations and acts as a liaison between Members, Physicians, Delegates, and Care Managers.

You will review service requests, prepare cases for clinical review, and coordinate benefits with members and providers. The position emphasizes medical terminology knowledge, good communication, and the ability to work under supervision, with benefits and compensation aligned to the job level.