Managed Care Navigator & Member Advocate

Empower Healthcare Solutions; Little Rock (AR); On-site; USD 23,000 - 33,000; Full time

Job summary

Empower Healthcare Solutions in Little Rock, AR seeks an entry-level Care Coordinator to manage and coordinate managed care services, including eligibility checks, referrals, and authorizations. The role liaises with providers, insurers, and patients to ensure compliant, efficient care delivery.

Responsibilities include member education, advocacy, and social determinants of health support, with emphasis on accurate documentation and regulatory compliance.

Qualifications

• High School diploma and one year experience in the mental health field.
• Bachelor's degree in healthcare, social work, Psychology or related field preferred.
• Knowledge of managed care principles, processes, and regulations.
• Familiarity with health insurance terminology, coverage, and benefits.
• Strong organizational and documentation skills.
• Excellent communication and interpersonal skills.
• Proficiency in using computer systems and software applications relevant to managed care operations.

Responsibilities

• Oversee coordination of managed care services, including verifying eligibility, managing referrals, and obtaining authorizations for medical procedures, treatments, and services.
• Deliver personalized health education and coaching to members based on identified concerns outlined in treatment and service plan, ensuring compliance with guidelines and policies.
• Provide member support access in addressing social determinants of health, such as facilitating access to exercise opportunities and nutritious food.
• Verify insurance coverage and benefits for patients, ensuring accurate and up-to-date information is obtained and documented.
• Conduct utilization reviews to evaluate medical necessity and appropriateness of care.
• Collaborate with insurance companies and healthcare providers ensuring availability and quality of services.
• Facilitate coordination with diverse healthcare providers for diagnostics, ambulatory care, and hospital services.
• Serve as a point of contact for members, addressing questions, concerns, and complaints related to managed care services, and advocating for their needs.
• Encourage initiatives aimed at improving patient health, including quality improvement initiatives and patient panel management.
• Coordinate community-based management of medication therapy.
• Ensure compliance with applicable laws, regulations, and contractual obligations related to managed care services.
• Maintain accurate and complete documentation of all interactions, authorizations, and communications.
• Identify opportunities for process improvement and efficiency enhancement in managed care operations.

Skills

Care coordination

Insurance verification

Education coaching

Member advocacy

Documentation

Education

High School diploma

2 Year Degree

Bachelor's degree preferred

Job description

Empower Healthcare Solutions in Little Rock, AR seeks an entry-level Care Coordinator to manage and coordinate managed care services, including eligibility checks, referrals, and authorizations. The role liaises with providers, insurers, and patients to ensure compliant, efficient care delivery.

Responsibilities include member education, advocacy, and social determinants of health support, with emphasis on accurate documentation and regulatory compliance.