Medicaid Care Coordination Specialist

Metropolitan Jewish Health System, Inc.; New York (NY); Hybrid; USD 55,000 - 68,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. is seeking a Care Management Coordinator to ensure high quality, cost-effective care and services for Elderplan/HomeFirst members.

The role supports care coordination for Medicaid and dual product members in compliance with CMS/DOH regulations, acting as a liaison among members, care management, and vendors. The position requires excellent communication and organizational skills, familiarity with utilization/case management, and prior managed care

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

• Process all newly enrolled cases according to established EP/HF Coordinated Care team workflows and maintain integrity of members’ files.
• Receive and process requests and inquiries through interdepartmental communication system regarding covered/non-covered services/supplies.
• Receive and process initial requests and inquiries regarding pre-authorization of services/supplies.
• Coordinate and provide service authorizations to vendors.
• Accurate and timely data entry support as defined by departmental workflows.
• Participate in scheduled team meetings.

Skills

Communication skills

Organizational skills

Care coordination

Interdepartmental communication

Education

High School Diploma or equivalent

College degree preferred

Job description

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.