Remote Behavioral Health Care Coordinator I

Horizon Blue Cross Blue Shield; Northern (KY); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Wellness programs

Tuition reimbursement

Volunteer time off

Job summary

Horizon Blue Cross Blue Shield of New Jersey invites applications for a Managed Care Coordinator I (Behavioral Health) fully remote in the United States. You will review service requests, collect data, and route cases for clinical review, coordinating with members, physicians, and providers to clarify benefits.

You will perform pre-certification screening, assist members with finding providers, triage referrals, and ensure timely case completion while upholding regulatory standards.

Qualifications

• High School Diploma/GED required.
• 1–2 years customer service or medical support experience preferred.
• Knowledge of medical terminology.
• Good oral and written communication skills.
• Ability to make sound decisions under supervision.
• Knowledge of contracts, enrollment, billing & claims coding/processing.
• Knowledge of Managed Care principles.
• Ability to analyze and resolve problems with minimal supervision.
• Proficiency with personal computers and applicable software/systems.

Responsibilities

• Review service requests for completeness and collect non-clinical data.
• Route cases for clinical review and coordinate with members and providers.
• Initiate calls/emails to clarify benefits and case completion.
• Screen pre-certification requests from physicians/members.
• Assist members in finding providers and scheduling, answer questions.
• Triage referrals from Member Services and providers.
• Review claims and address gaps in preventative care.

Skills

Medical terminology

Written communication

Decision making

Problem solving

Team player

Interpersonal skills

PC skills

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey invites applications for a Managed Care Coordinator I (Behavioral Health) fully remote in the United States. You will review service requests, collect data, and route cases for clinical review, coordinating with members, physicians, and providers to clarify benefits.

You will perform pre-certification screening, assist members with finding providers, triage referrals, and ensure timely case completion while upholding regulatory standards.