Remote Senior Managed Care Coordinator II

Horizon Blue Cross Blue Shield; New Jersey; Remote; USD 50,000 - 67,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Managed Care Coordinator II to support Clinical Operations, coordinating benefits and care for members. You will review requests, collect data, and route cases for clinical review while assisting in onboarding and liaising with providers and care managers.

The role requires strong communication, medical terminology knowledge, and the ability to work with non-clinical staff under supervision.

Qualifications

• High School Diploma or GED required.
• 3-5 years of customer service experience.
• Medical certification translator education is preferred for Letters Team roles.

Responsibilities

• Review service requests for completeness and collect data for clinical review.
• Prepare, document and route cases in the system for clinical review.
• Make outbound calls to members/providers to coordinate benefits and care.
• Assist with onboarding and training of new Managed Care Coordinators I.
• Act as liaison with providers, members and Care Managers.
• Support case management and utilization management workflows.

Skills

Medical terminology

Oral and written communication

Decision making

Contracts knowledge

CMS regulatory knowledge

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Managed Care Coordinator II to support Clinical Operations, coordinating benefits and care for members. You will review requests, collect data, and route cases for clinical review while assisting in onboarding and liaising with providers and care managers.

The role requires strong communication, medical terminology knowledge, and the ability to work with non-clinical staff under supervision.