Care Coordination Specialist I

Horizon Blue Cross Blue Shield; Northern (KY); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a team-oriented professional to support Clinical Operations as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.

You will review service requests for completeness, collect non-clinical data, coordinate with providers, perform case management tasks, support utilization management, and assist with letters review to ensure accurate and compliant processing.

Qualifications

• High School Diploma/GED required.
• Prefer 1-2 years customer service or medical support related position.
• Knowledge of Medicaid CM preferred.
• Good oral and written communication skills.

Responsibilities

• Review service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
• Prepare, document and route cases in appropriate system for clinical review; initiate call backs and correspondence to members and providers.
• Assist with Utilization Management and Case Management tasks, including coordination of services and health assessments.
• Triage referrals, handle PCP/demographic changes, and support letters review for regulatory compliance.

Skills

Medical terminology

Communication skills

Decision making

Contracts knowledge

Managed Care

Problem solving

Software literacy

Team player

Analytical skills

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a team-oriented professional to support Clinical Operations as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.

You will review service requests for completeness, collect non-clinical data, coordinate with providers, perform case management tasks, support utilization management, and assist with letters review to ensure accurate and compliant processing.