Managed Care Coordinator

eTeam; Hopewell (NJ); On-site; USD 28,000 - 29,000; Full time

Job summary

eTeam in New Jersey is hiring for a health services support role to liaise among Members, Physicians, Delegates, and Client Service Coordinators. You will review service requests, collect data, and coordinate with clinical staff on pre-certification processes.

The position requires a minimum of 3 years in customer service within a Managed Care setting, with professional communication and data handling. Duration is 6 months and compensation ranges per hour.

Qualifications

• Requires minimum of 3 years of customer service experience, preferably in a Managed Care environment.

Responsibilities

• Performs review of service requests for completeness and data collection.
• Screening for pre-certification requests from physicians/members using scripts/workflows.
• Prepare, document and route cases for clinical review.
• Coordinate benefits with members and providers via calls or correspondence.
• Coordinate/clarify case completion with physicians/members after inquiries.
• Review professional medical/claim policy issues or claims in pending status.
• Authorize services based on collected information per scripts/algorithms.
• Non-clinical staff do not perform clinical UM reviews.
• Perform other tasks as assigned by Management.

Skills

Customer service

Telephone sales

Managed Care

Education

High School Diploma/GED

Job description

Pay Rate: $(20.00 - 21.42)/hr on W2 all-inclusive without benefits

Duration: 06 Months

Job Description:

• This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.

Responsibilities:

• Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.


• Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.


• Prepare, document and route cases in appropriate system for clinical review.


• Initiates call backs and correspondence to members and providers to coordinate and clarify benefits.


• Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion.


• Reviewing professional medical/claim policy related issues or claims in pending status.


• Upon collection of clinical and non-clinical information ClientC can authorize services based upon scripts or algorithms used for pre-review screening.


• Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information.


• Perform other relevant tasks as assigned by Management.

Job Qualifications:

Education/Experience:

• High School Diploma/GED required.


• Requires a minimum of 3 years of experience in customer service, telephone sales preferably in a Managed Care environment.