Medical Care Coordinator

spectrumhealth; Grand Rapids (MI); On-site; USD 52,000 - 75,000; Full time

Benefits offered by this job

Comprehensive benefits package

On-demand pay program

Discounts directory with deals

Identity protection options

Retirement options with match

Job summary

Corewell Health in Grand Rapids seeks a healthcare professional to coordinate, outreach to and respond to members regarding issues related to medical conditions, benefits and coverage criteria. You will navigate members through complex systems across the health plan and care network to help them understand their care options.

Under supervision of a licensed Care Manager, you will guide members through Priority Health networks, perform routine tasks for benefits and prior authorizations, and

Qualifications

• Associate's Degree with a health care focus or related field.
• 3 years of relevant experience in a managed care/healthcare environment.

Responsibilities

• Navigate members through our health plan and care network to explain care options.
• Serve as the first point of contact into Care Management and assess needs.
• Guide members through Priority Health networks and internal/external resources.
• Act proactively on routine benefits, gaps in care and prior authorization processes.
• Support members at rising risk with delegated disease education under supervision.

Skills

Care coordination

Member advocacy

Complex case navigation

Prior authorization

Health plan knowledge

Education

Associate's Degree in healthcare

Job description

Job Summary

A healthcare professional with a customer centric focus to coordinate, outreach to and respond to members regarding issues and questions related to medical conditions, benefits and coverage criteria. 1) Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options. 2) Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc. 3) Act proactively on member's behalf with routine benefits, gaps in care and prior authorization processes. 4.) Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.

Essential Functions

• Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.
• Is the member's first point of contact into Care Management. Assesses and identifies the needs and evaluates to determine if the member needs complex care management. If the needs are not complex, assists the member to meet their health care needs.
• Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.
• Acts proactively on member's behalf with routine benefits, gaps in care and prior authorization processes.
• Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.
• Identifies barriers and social determinants of health and assists to address or eliminate these barriers.
• Manages a caseload of approximately 150-300 members with stable but complex conditions or rising risk related to chronic conditions.

Qualifications

Required Qualifications

• Associate's Degree with a health care focus or Skills/knowledge/abilities typically gained through less than 2 years of related work experience in a clinical office or health insurance setting.
• 3 years of relevant experience Working in an organization of size and complexity comparable to Corewell Health or managed care organization

Preferred Qualifications

• 5 years of relevant experience Related work in a clinical office or health insurance setting

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here .
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids

Department Name

Care Management DSNP - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture w