Care Management Coordinator

MJHS; New York (NY); On-site; USD 60,000 - 80,000; Full time

Job summary

MJHS’s Elderplan and HomeFirst programs in New York, NY seek a Care Management Coordinator to ensure high-quality, cost-effective care for Medicaid/dual members. You will support care coordination activities, liaise with members, the care management team, and vendors, and help maintain CMS/DOH compliance.

The role requires strong communication and organizational skills, with prior managed care experience and healthcare setting familiarity valued.

Qualifications

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

Responsibilities

• Process newly enrolled cases per established Care Management workflows and maintain member files.
• Process requests and inquiries about covered vs non-covered services/supplies.
• Handle pre-authorization requests for services and supplies.
• Coordinate and provide service authorizations to vendors.
• Provide accurate and timely data entry per departmental workflows.
• Participate in scheduled team meetings.

Skills

Managed care experience

Utilization management

Care coordination

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.
The Care Management Coordinator is expected to ensure high quality, cost-effective care and services for Elderplan/HomeFirst members through support of professional Care Management activities. The position supports all aspects of care coordination for our Medicaid, and/or dual product members in compliance with all departmental and CMS/DOH regulatory requirements. The position requires excellent communication and organizational skills to facilitate superior care management and to act as a liaison between the members, the care management team, and the vendors.

• 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.