Care Management Coordinator

Metropolitan Jewish Health System, Inc.; New York (NY); On-site; USD 45,000 - 60,000; Full time

Job summary

A leading healthcare organization in New York is seeking a candidate to manage newly enrolled cases and provide support in a fast-paced environment. This role requires at least one year of managed care experience and familiarity with utilization management. The ideal candidate will have strong data entry skills and effectively handle requests regarding services. Join this organization to contribute to high-quality healthcare services.

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 team workflows.
• Receive and process requests regarding services.
• Coordinate service authorizations to vendors.
• Provide accurate data entry as required.

Skills

Managed care experience

Data entry

Interdepartmental communication

Education

High School Diploma or equivalent

College degree

Job description

Overview

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.

Responsibilities

• 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

Qualifications

• 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.