Care Management Coordinator

MJHS; New York (NY); On-site; USD 50,000 - 65,000; Full time

Job summary

A healthcare organization in New York is seeking a Care Coordinator to support care management and clinical service activities for Medicare and Medicaid members. The ideal candidate will process enrollment cases, handle service requests, and ensure high-quality care through efficient coordination. A High School Diploma is required, with preference given to candidates with a college degree and prior managed care experience. This position offers an opportunity to impact patient care positively.

Qualifications

• One year prior managed care experience required.
• Prior experience in a health care setting preferred.
• Familiarity with utilization management/case management.

Responsibilities

• Process newly enrolled cases according to established workflows.
• Receive and process requests regarding covered/non-covered services.
• Coordinate and provide service authorizations to vendors.
• Participate in scheduled team meetings.

Skills

Managed care experience

Utilization management knowledge

Communication skills

Education

High School Diploma or equivalent

College degree (preferred)

Job description

Come lead with us at New York, NY

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Insure high quality, cost-effective care and services for Elderplan members through support of professional Care Management and/or Clinical Service activities. The position supports all aspects of care coordination for our Medicare, Medicaid, and/or dual product members in compliance with all departmental and regulatory requirements.

• 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
• 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.