Remote Managed Care Coordinator I – Case Management

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

Benefits offered by this job

Comprehensive health benefits (Medical

Dental/Vision benefits

Retirement Plans

Generous PTO

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Managed Care Coordinator I to support Clinical Operations. You will review service requests, gather information, coordinate with members and providers, and assist in case management and pre-certification workflows.

Responsibilities include liaison work with care managers, handling inquiries, and guiding members through accessing services and filing appeals.

Qualifications

• Knowledge of medical terminology.
• Good oral and written communication skills.
• Ability to make sound decisions under supervision.
• Familiarity with contracts, enrollment, billing & claimscoding/processing.
• Prefers knowledge of Managed Care principles.

Responsibilities

• Reviews service requests for completeness and collects data.
• Routes cases for clinical review and initiates callbacks to members and providers.
• Coordinates case completion with physicians/members.
• Reviews claims and policy-related issues.
• Acts as liaison with providers, members and Care Managers.
• Screens pre-certification requests from physicians/members using scripts.

Skills

Medical terminology

Oral and written communication

Team player

Analytical skills

Interpersonal skills

Knowledge of Medicaid CM

Contracts enrollment billing & claims

Managed Care principles

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Managed Care Coordinator I to support Clinical Operations. You will review service requests, gather information, coordinate with members and providers, and assist in case management and pre-certification workflows.

Responsibilities include liaison work with care managers, handling inquiries, and guiding members through accessing services and filing appeals.