Care Management Coordinator — Medicaid/DUAL Plans

Metropolitan Jewish Health System; New York (NY); On-site; USD 40,000 - 44,000; Full time

Benefits offered by this job

Tuition Reimbursement

Generous paid time off

Affordable medical, dental and vision

Two retirement plans: 403(b) and成绩P

Flexible spending

Job summary

Metropolitan Jewish Health System is seeking a Care Management Coordinator to ensure high-quality, cost-effective care for Elderplan/HomeFirst members. You will support Medicaid/dual product care coordination, comply with CMS/DOH requirements, and act as a liaison among members, the care management team, and vendors.

The role requires strong communication and organization skills, with prior managed care and healthcare experience preferred.

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.

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.

Skills

Care coordination

Communication skills

Utilization management

Education

High School Diploma or equivalent

College degree preferred

Job description

Metropolitan Jewish Health System is seeking a Care Management Coordinator to ensure high-quality, cost-effective care for Elderplan/HomeFirst members. You will support Medicaid/dual product care coordination, comply with CMS/DOH requirements, and act as a liaison among members, the care management team, and vendors.

The role requires strong communication and organization skills, with prior managed care and healthcare experience preferred.