Care Coordination Specialist — Managed Care

Metropolitan Jewish Health System, Inc.; New York (NY); Vor Ort; USD 65.000 - 85.000; Vollzeit

Zusammenfassung

Metropolitan Jewish Health System, Inc. is seeking a Care Management Coordinator to ensure high quality, cost-effective care for Elderplan/HomeFirst members. You will support care management activities, liaise between members and vendors, and ensure CMS/DOH regulatory compliance.

The role requires strong communication and organizational skills, experience in managed care, and familiarity with utilization management. Join a team focused on coordinating services and improving member outcomes.

Qualifikationen

• High School Diploma or equivalent; college degree preferred.
• One year prior managed care experience required.
• Prior experience in a health care setting preferred.
• Familiarity with utilization management/case management.

Aufgaben

• Processes all newly enrolled cases according to established EP/HF Coordinated Care team workflows and maintains integrity of members’ files.
• Receives and processes requests and inquiries through interdepartmental communication system regarding covered/ non covered services/supplies.
• Receives and processes initial requests and inquiries regarding pre-authorization of services/supplies.
• Coordinates and provides service authorizations to vendors.
• Accurate and timely data entry support as defined by departmental workflows.
• Participates in scheduled team meetings.

Kenntnisse

Communication

Organization

Care coordination

Utilization management

Ausbildung

High School Diploma or equivalent

College degree preferred

Tools

Interdepartmental communication system

Data entry system

Jobbeschreibung

Metropolitan Jewish Health System, Inc. is seeking a Care Management Coordinator to ensure high quality, cost-effective care for Elderplan/HomeFirst members. You will support care management activities, liaise between members and vendors, and ensure CMS/DOH regulatory compliance.

The role requires strong communication and organizational skills, experience in managed care, and familiarity with utilization management. Join a team focused on coordinating services and improving member outcomes.